Sick Skip Treatment Because They Can't Prove Obamacare Coverage

Saturday, 04 Jan 2014 10:44 AM

By Sandy Fitzgerald

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Hospital emergency rooms indicate they are not being flooded with patients as predicted with the advent of Obamacare — but some people are taking a pass on treatment because they can't prove they're covered.

Patients have been walking away from hospitals after learning that they would have to pay hundreds of dollars for treatment because they didn't have insurance cards,  reports The Daily Mail, a British newspaper.

Maria Galvez, told the Mail she left a Virginia hospital without getting a needed chest X-ray because it would cost her $500 without proof of her Obamacare coverage.

"The people in there told me that since I didn’t have an insurance card, I would be billed for the whole cost of the X-ray,” she said. “It’s not fair. You know, I signed up last week like I was supposed to.”

She said she enrolled on the Obamacare website three days before Christmas in a plan costing $450 a month, but "nobody has sent me a bill."

Another woman said she was not able to get emergency services at the Inova Alexandria Hospital, where she went after suffering chest pains.

"They took me in the emergency room," the woman, who identified herself only as Mary,  told the Mail. "They told me they were going to admit me, but when I told them I hadn't heard from my insurance company since I signed up, they changed their tune."

A nurse told her that her bill would be around $3,000 a day if she stayed, so she chose to leave.

"What if I think I'm covered and I'm really not? she said. "The emergency room bill is going to be bad enough."

Nationally, medical providers say they're only seeing a trickle of patients, while insurers, hospitals, and doctors work to determine who is really covered.

More than two million people signed up for Obamacare plans in time for them to take effect on Wednesday.

In some places, people are getting treatment but providers are holding off filing the claims.

For example, Central Ohio Primary Care's Chief Executive Officer Dr. William Wulf said he would hold off on claims until it can confirm membership information.

"What we're doing is we're seeing the patients, trusting they are in fact going to pay for insurance, and just not sending a bill yet," Wulf said.

Meanwhile, ZocDoc, a company that allows patients to find doctors and schedule appointments online, reports people started making appointments through their Obamacare plans in December. But those making appointments through ZocDoc don't seem have serious medical needs, as was feared, said Dr. Oliver Kharraz, the company's founder and chief operating officer.

Pharmacists also said they're not seeing any surge in demand beyond what usually happens when insurance changes take effect. But Walgreens spokeswoman Markeish Marshall said the company anticipates more activity next week.

Even people who are confirmed for coverage are finding that their out-of-pocket costs are so high they will have trouble staying out of debt.

"Cost may still be an issue for those in need of the most care," said Steven Weiss, spokesman for the American Cancer Society Cancer Action Network. That "makes it critically important for patients looking at premiums to also consider out-of-pocket costs when choosing a plan."

Under the law, insurance companies competing in new online markets like can offer four levels of coverage.

All plans cover the same benefits; the difference is in financial protection. A bronze plan covers 60 percent of expected costs, silver covers 70 percent, gold covers 80 percent, and platinum covers 90 percent.

Bronze plans have the lowest premiums, but provide less coverage. Gold plans are the closest to employer-provided coverage.

Silver, however, is the standard for most consumers. The law's tax credits to help with premiums are keyed to a benchmark silver plan in each geographical area. And the law's subsidies to help with out-of-pocket costs are only available to people who get a silver plan.

Avalere found that the average annual deductible for silver plans is $2,567, more than twice what workers in employer plans currently face. Additionally, many silver plans have high cost-sharing requirements for prescriptions, particularly "specialty drugs" to treat intractable conditions such as severe forms of arthritis.

Reuters contributed to this report.

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