Health Insurance Coverage lacking for some

By Michelle L. Start
mstart@news-press.com
Originally posted on July 07, 2006

It's a bill Leslee Botello wasn't expecting: $7,000 to treat her son's broken knuckle at Lehigh Regional Medical Center's emergency room.

Botello has health insurance and was told it would cover the hospital visit because the hospital was part of her insurer's medical-care network.

"I pay $600 a month to have health insurance and I don't make that much money," said Botello, 37, of Lehigh Acres.

Pat Schoeni, executive director for the National Coalition on Health Care, said stories like Botello's are more common.

"This is why we need health insurance reform," she said. "This is not happening to just poor people. It's the middle-class people who are suffering. The reason people ought to care is that it can happen to any of them."

While there is help available for the uninsured, those with insurance do not qualify for much, if anything, in the way of assistance. Reduced costs for prompt payment and, sometimes, payment plans are the only options available.

The coalition is a nonprofit, nonpartisan organization that focuses on improving health care.

Costs rising

A study prepared by PricewaterhouseCoopers on behalf of America's Health Insurance Plans found that higher use of services, increased consumer demand, new and more intensive medical treatments as well as aging and unhealthy lifestyles all contribute to the rising costs of health insurance.

America's Health Insurance Plans is a national association representing nearly 1,300 health insurance companies.

"It is getting to the point that people in the middle class are having to decide if they buy health insurance or if they pay for housing, food and all of those other things," Schoeni said. "It is becoming more and more of an issue for a lot of people."

The skyrocketing costs are leading more people to drop insurance, change their lifestyles or file for bankruptcy. Schoeni said that nearly half the people who have filed for bankruptcy have listed medical bills as a contributing factor.

While Botello's son was at the hospital for less than three hours in late April, the total bill exceeded $21,000. Her portion of that, after insurance kicked in their share of costs, was $7,000.

Botello called relatives, begging them to lend her $3,200, which the hospital agreed to accept as payment-in-full.

Officials with Lehigh Regional Medical Center declined to comment on the case, as well as anything insurance-related, citing concerns it might ruin the hospital's relationship with insurance carriers.

They said, however, the hospital is a for-profit center and, therefore, does not have many of the programs to help offset costs as other area hospitals.

Coverage at risk

Already 45 million Americans have no health coverage and the 255 million who do have it are at risk of losing it, according to Schoeni.

The statistics have Lee Memorial Health System president and chief executive officer Jim Nathan pushing for reform. At board meetings, Nathan speaks about the impact of the uninsured and underinsured on Lee County's medical care.

"Most of our programs are geared toward the uninsured. We don't (typically) discount for insured patients," said Billie Jo Debolt, system director for business services at Lee Memorial Hospital. "But, we do have some programs, like our prompt payment discount. If the bill is paid in full within 30 days, it can be 30 percent of the balance. We have sliding-scale discounts based on a person's income. If a person falls within 300 percent of federal poverty guidelines, they may be entitled to a 40 percent discount. If they fall within 400 percent, there may be a 30 percent discount."