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Authors

  1. Section Editor(s): Rodts, Mary Faut DNP, CNP, ONC, FAAN
  2. Editor

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With the advent of the new Health Exchange insurance programs that have begun to be rolled out across the country, patients and providers are just beginning to see what this actually means. There is tremendous confusion about what the new policies mean to both providers and patients.

  
Mary Faut Rodts, DNP... - Click to enlarge in new windowMary Faut Rodts, DNP, CNP, ONC, FAAN Editor

Unfortunately, many people who signed up for these new programs often did not understand what the basic coverage was. Purchasing health insurance in any situation can often be confusing. Even with a good explanation, if never having had to evaluate the "fine print" of an insurance policy, it was and continues to be overwhelming. Many patients based their decisions solely on the monthly premium and that is understandable. Affordability has to be the greatest consideration; however, now they are faced with problems: access to providers who accept their plans as well as high deductibles that they will also be responsible for, are just two of the problems.

 

For the patient who has never had health insurance, access to care is not new. For someone who had insurance and was forced to change because of employer mandate now may be faced with less access due to the provider's lack of understanding or nonparticipation with these new plans. This is a new challenge that is difficult to understand; the person has purchased health coverage, yet access is still difficult.

 

The additional problem is the lack of understanding of just what a deductible means. Some patients had no understanding when the new health exchange plan was purchased that the deductibles, in many situations, are in the thousands of dollars. It has been reported that silver and bronze plans created by the Affordable Care Act carry average family deductibles of $6,000 and $10,386, respectively (Beck, 2014). As initial bills that are being managed under these new plans are being adjudicated and the deductible amount is applied, patients are shocked at what they now owe to providers.

 

For the providers, because of the lack of clarity and evolving situation regarding the various plans, providers struggled to figure out what it would mean to them. What was known was that more people would have some form of health coverage that would potentially increase the volume of patients requesting care. Providers started to strategize about what changes would need to be made to help with an increased number of patients. Fortunately, the adoption of these new health plans has been slower than anticipated, which is allowing providers to sort this out.

 

Second, providers are now faced with high deductible plans that patients have purchased and did not fully understand the responsibility that goes with these plans. Providers are now trying to explain this to their patients after care has been rendered. Setting up payment plans for these patients is often necessary and now sets up a delay in payment for the providers. Even worse, will payment ever be received?

 

As an orthopaedic nurse, you may hear patients voice frustration over the changes to their healthcare insurance. Because there can be variability at the state level regarding the available health plans, their details, and costs, it would be good to begin to look at exactly what is going on in your state. As a start, here are two websites that help you begin:

 

http://HealthCare.gov allows you to look at plans available in your state: https://www.healthcare.gov

 

National Public Radio presented easy-to-understand frequently asked questions regarding the new health insurance exchanges: http://www.npr.org/2013/10/11/230916150/faq-all-about-health-insurance-exchanges

 

 

Reference

 

Beck M. (2014). How to bring the price of health care into the open. Wall Street Journal. Retrieved February 28, 2014, from http://online.wsj.com/news/articles/SB10001424052702303650204579375242842086688[Context Link]