Healthcare Consumer Protection

Navigating your rights and responsibilities in the healthcare marketplace can be a complicated task, making it difficult for you to be an informed healthcare consumer. Inadequate or incomprehensible information may cause you to not be aware of your options in reaching sound and economical healthcare choices. That is an unacceptable outcome. And, it is an outcome that is becoming more troublesome because, as healthcare expenses rise, the cost of healthcare is being shifted to YOU, the healthcare consumer.

  • Insurance premiums are rising.
  • Some employers are paying a lower percentage of the premium, shifting premium costs to the employee and his/her family.
  • Some employers have opted to make a cash amount available to the employees to use to purchase plans directly from an insurance company or on an exchange. However, the scope of benefits and the price of the policies are not always as affordable as when the employer negotiates on behalf of a large group of employees.
  • The cost of healthcare services varies among doctors, hospitals, and other medical facilities.
  • Prescription drug costs vary, often significantly, among pharmacies or physicians dispensing the drugs.
  • Deductibles are increasing. Even though the Affordable Care Act (Obamacare) established maximums, the floor deductible is rising.
  • Co-pays are increasing and the percentage of co-insurance the employee must pay is rising.
  • The increased use of high deductible health plans, a type of insurance plan where the minimum annual deductible is equal to or greater than $1,250 per individual or $2,500 for a family, includes additional restrictions:
    • Maximum annual deductible is limited to $6,250 for an individual and $12,500 for a family.
    • Adding a health savings plan, HSA, provides some advantages, but also includes special restrictions.

You have the right to receive accurate and easily understood information about your health plan, healthcare providers (doctors, hospitals and other facilities), and the available options that will maximize quality treatment and minimize your cost. You have the right to know the cost and quality of the healthcare you are paying for and receiving before you decide about treatment options and provider or product selection. To become an informed consumer, healthcare insurance companies and providers should disclose fundamental and essential price and quality information before your treatment option is selected, including:

  • The estimated costs of procedures, drugs, providers, and facilities.
  • Comparative price information with respect to providers, devices and prescription drugs. The costs for healthcare – including, the costs for services, procedures, hospitals, drugs, and implantable medical devices – vary dramatically, even within a small geographic region.
  • Comparative quality data with respect to providers, medical devices and drugs.
  • An alert when a provider is not part of your health plan’s network (out-of-network services and providers) so that you will not be surprised by your likely incurring a higher cost with an out-of-network provider.

However, there are often barriers to obtaining such knowledge and understanding. For example:

  • Healthcare consumers have limited ability to ascertain reliable price estimates for healthcare services before those services are performed or provided.
  • Healthcare consumers rarely are able to “comparison shop” for healthcare products and services.
  • Healthcare consumers are limited in securing quality data about healthcare providers.
  • Healthcare consumers are unaware that a higher cost does not always mean the quality is better; it could be worse. A lower priced provider may deliver superior healthcare services.
  • Healthcare consumers receive from their insurance carrier explanations of benefits (EOB) that are incomprehensible, often vary significantly from cost estimates, or contain charges that are inaccurate or are for products and services they did not receive.
  • Healthcare consumers unknowingly are provided care by out-of-network providers and then charged usually higher out-of-network rates for products and services, often without notice or the ability to select less costly alternatives.
  • Some healthcare providers are demanding patients provide a deposit before a medical service is provided. In addition to being an additional financial burden, the patient has the burden to determine if the deposit exceeded the applicable deductible and co-insurance and demand reimbursement from the provider of any excess deposit.

If you believe that your rights as a healthcare consumer have been infringed or you have not been fairly treated, the attorneys at C&T offer a free consultation to review your situation and help you understand whether your legal rights as a healthcare consumer have been violated.

We’re ready to assist you, so call us or click here to discuss your situation.