First of all I have to say that this Blog was inspired by Brigid Sweeney from Crain’s Chicago entitled ” More Hospitals are getting stiffed on patients bills” I have to admit the headline grabbed me immediately. So the Affordable Care Act (ACA) that many thought was affordable, has a new twist to it.  Not only is not affordable to the consumers but it is not affordable to the medical providers.  One of the pros of  the ACA was that more people would be insured, medical providers would be able to bill insurance companies and receive more revenues as result of people having insurance policies. Well the latest reports tells a different story. While more people have insurance policies, deductibles and out of pockets are much higher then they have ever been and as result patients are refusing to pay the first dollar costs. Why, because many of them can not afford it.  So many of them still seek medical attention much later then they should because they can not afford the out of pocket expenses. So as it has been historically, the conditions get worse because of the lack of upfront treatment. When they do seek treatment they go right past the deductible and out of pocket expense leaving the hospital and/or doctor left to collect the portion of the claims that the insurance company didn’t cover. A couple points on this issue. More than 85% of claims are below $10,000 which is about the where most people’s deductibles are since the ACA was implemented.  That being said, patients are responsible for the majority of their medical claims because insurance doesn’t kick in until after the annual deductible is met. Medical providers have a harder time collecting the deductible and out of pocket costs for many reasons, One being the notorious Dodd-Frank Act and other administrative laws that put limits on collection activities. Much easier to collect on a $25,000.00 medical claim than on $2,500.00 claim. The only way to bring health care costs is to have a combination of public and private pay healthcare system in the USA. Costs will decrease and patients will have a choice of purchasing affordable medical insurance. The sooner the US government realizes that health care and medical insurance are two different things, we can work towards a solution


Tim Elenz



“Medical insurance is our specialty”

800-317-0181 ext. 306


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