A recent article in an area business journal quoted a Census Bureau report announcing that another 1.3 million Americans have been added to the uninsured roles, totaling 46.6 million nationally. Almost all of the increase in the uninsured came from working adults. Although last year’s annual average increase in premiums was 9.2%, the increase followed four consecutive years of double-digit increases. One writer pointed out that it is the low-wage workers who are being hurt the most. Small business owners are responding to these premium increases by dropping their insurance coverage altogether.

Another employer response is to off-load more of the cost to employee/patient responsibility. It is facetious to declare that the term “underinsured” is a euphemism for the “almost-insured”, but I will offer an example. Recently it was time for our company to renew our employee health insurance policy. Facing a double-digit premium increase, our response was that of other employers; we converted to a high deductible plan in exchange for the same premium. These plans are known by different descriptors, Health Savings Accounts, Health Reimbursement Accounts, and Consumer Driven Health Plans. When the benefits broker estimated that only 4% of our employees would ever hit the maximum deductible in a year’s time period, it seemed as if our employees were “almost” insured. In fact, we felt compelled to add a cafeteria plan so that the employees could at least get the benefit of some tax savings for medical care. 

From a medical billing perspective, this is of concern. Most computer billing systems are designed to capture data based on a person’s insurance status. This classification obviously will, over time, be deceptive. More emphasis will be required on measurement to determine what portion of the accounts receivable is due from the insurance company and how much is due directly from the patient. Not only will this have the impact of reducing the overall gross collection rate, it will slow the velocity of the collection cycle. For example, the process starts with billing a patient’s insurance company. A few weeks later, the company either sends payment or states on the Explanation of Benefits (EOB) why payment was denied. With high deductible plans, the EOB will state that the amount billed is within the patient’s deductible. It is following this delay that a bill would finally be sent to the patient/guarantor.

There is, however, a glimmer of hope amidst all of this doom and gloom. A major payor is experimenting with a new medical insurance plan in which the insurance company pays the physician the total amount due and then collects co pays and deductibles directly from its members. If a member fails to pay, then the employer will deduct the amount due from the member’s next paycheck. It will be our endeavor to fully support and encourage this development. This seems to be the way it should have been in the first place.