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Many New Insurance Policies Feature High Out-Of-Pocket Costs For Patients

March 24, 2015 – Experts Down The Hall – Eileen Ramos

Source: New York Times– February 7, 2015

As many Americans are using their insurance policies purchased from the Health Insurance Marketplace under the Affordable Care Act, they are finding that those policies come with high deductibles and increasing out-of-pocket coinsurance fees while also offering less coverage than ever before, according to a recent article in The New York Times.

The Affordable Care Act (ACA) has improved insurance in some respects. The law states insurance companies cannot deny coverage for pre-existing conditions, and new policies limit out-of-pocket spending for care under those policies. However, many people are encountering out-of-pocket costs they traditionally weren’t responsible for in previous private or company-sponsored policies. This is because, in an effort to reduce their own financial risk, insurance companies are creating policies to meet the minimum criteria of the law.

In this new insurance landscape, patients will need to become better-informed health care consumers and learn how to interpret their new plans to avoid unexpected costs of care.

New ACA policies are unfamiliar to patients and providers, and interpreting these policies has become problematic for everyone involved. In this new insurance landscape, patients will need to become better-informed health care consumers and learn how to interpret their new plans to avoid unexpected costs of care.

From Our Expert, Eileen Ramos

“RADfertility is here to help patients understand their insurance benefits.”

Many policies are costing more money for less coverage, but this is not limited to only Marketplace Plans. One of the biggest changes patients will find with these new plans is that deductible and co-insurances may be much higher. The policies themselves have quickly become very complicated, and a lot of it doesn’t seem logical.

To meet their deductible or co-insurance, patients with infertility coverage are also increasingly putting more money up front to pay for procedures that diagnose infertility. Another challenge is that in some cases, where patients have no infertility coverage, their annual out-of-pocket maximums in their plans are so high that they have essentially become self-pay.

At RADfertility, we try to do our best to make sure you understand your insurance benefits. We call your insurance companies and get as much information as possible about your benefits and whether you have any benefits specifically related to diagnosing and treating infertility. We also try to find out your estimated out-of-pocket cost at each visit based on this information.

At your new patient visit, you will sit with a member of our financial team and review your benefits in a one-on-one session. However, it’s important to know that we are just as subject to what your insurance company says as you are. Unfortunately, we cannot offer any guarantees about your insurance coverage because companies only offer a statement of your benefits, and not a guarantee that your insurance will cover certain services.

The best way to understand what your insurance policy covers is to become an advocate for your own care. We have created several handouts outlining how to understand your insurance benefits, how to contact your insurance company yourself, and what questions to ask them. My advice to our patients is to ask questions, stay informed, and don’t lose hope! Between 10% and 15% of the population will experience fertility challenges at some point in their lifetimes. It’s important to know you are not alone on your journey.

I’ve seen patients become disheartened after learning their insurance coverage wouldn’t cover their treatment. But it doesn’t mean you can’t have that baby. We have financial options to help you through this difficult time. We want you to be informed so you know the potential benefits and limits of your coverage ahead of time. Know we are here, you’re not alone, and we’ll do our best to help you through it.



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