(By: Brittany Brooks)
The ongoing pandemic of rising hospital costs continues to plague Americans and their mental health. The unfortunate aspect of it all is there may not be an end in sight.
It’s no secret that the average hospital bill gets more expensive every year; in fact, one-third of all healthcare spending in the US goes toward hospital care, specifically. Maybe this does more than just correlate with the fact that 31% of Americans think they won’t be able to pay their medical expenses over the next 12 months.
But we’re not here to complain, we’re here to discover what’s impacting the consistent rise in hospital costs. Below, we discuss the three major factors influencing crippling hospital bills (and a little something extra).
Discover, too, about surprise billing, and how healthcare networks used to sneak it into every medical bill. Thanks to the “No Surprises Act” that saved future generations from the burden of surprise hospital bills, we can officially say healthcare networks “used to” sneak it in.
Three Major Factors Impacting Hospital Bills
The US healthcare system is based on an insidious “pay-per-service business model”, and weighs in as the top contributor to high-cost medical expenses. Pay-per-service is exactly how it sounds; hospitals and healthcare providers charge you for each rendered service in a visit or call.
This type of business model incentivizes hospitals and medical providers to prioritize billable tests, treatments, and services for the sake of profit; while health insurance companies fight to deny as many expenses as possible.
Ah, the dark side of the pay-per-service system. Even with health coverage, it’s the individuals that become the victims in the tug-of-war between hospitals and insurance companies.
Since the premise is that insurance will pay for most of the bill, and leave only a small portion for the insured to pay out-of-pocket medical expenses can rack up quite a tab. Between deductibles, copays, and prescription costs, one hospital visit can make anyone start to feel like an employer themselves!
We’re Not Getting Any Healthier
In the National Library of Medicine’s (NLM) report, Front-Of-Package Nutritional Rating Systems and Symbols: Phase 1, wherein the Standard American Diet that was the subject of the analysis, our nutritional intake came up as sorely lacking. (Dare we suggest causation?)
The typical American diet consists of an excessive amount of:
- Saturated fats
- Added sugars
Severely lacking some of the essential building blocks of a healthy diet, e.g., fiber, calcium, potassium, and Vitamin D., our nationally accepted standard of eating directly impacts the nation’s health at large.
The imbalance contributes to a higher number of health risks, such as:
- Heart Disease
- Cancer (of many forms)
Worth noting: Obesity is an ongoing pandemic in America of its own, with roughly 40% of adults between the ages of 20-39 being diagnosed as either obese or overweight. Unless we start making healthier choices, we can expect to see this number rise.
Between a poor diet and obesity, we can most certainly anticipate more expensive hospital bills.
Market Competition Is Decreasing – Read: Monopolies Are BACK
As more medical facilities, medical care providers, and insurance companies merge, the costs to cover their services will inevitably continue to climb – as will their prices. As medical care networks forge partnerships and acquisitions, the market competition shrinks.
We’re all familiar how it starts: a small medical care investment is made here and there, by a small firm. They quietly acquire a local hospital or two, left unchecked, and before long, the same firm has bought out all the private medical entities, insurance services, and clinics in the county.
While a thrilling expansion for the investors, this obviously results in the medical care network and insurance companies hiking prices at will.. Remember the pay-per-service model mentioned earlier? Unfortunately, it hurts more individuals than it helps… Individuals like your employees.
A pretty self-explanatory term, Surprise Billing refers to the hospital + insurance carrier practice of structuring an individual’s health coverage in such a way that it almost always ensures out-of-pocket costs for the “insured”.
More than half of all Americans have been the victim of such unsuspecting circumstances. Picture it; you go on vacation for the first time in a while. You’re still in the States, and you have your health coverage from your employment. So when an ungodly stomach ache hits, you don’t hesitate before checking into a hospital, and getting emergency care.
Little did you know, the doctor, the hospital, the emergency staff (separate from the rest of the hospital), and the time you spent in the facility, all cost you the equivalent of your mortgage, because the hospital was “out of network”.
Enter the No Surprises Act.
Effective as of Jan 1, 2022 The No Surprises Act aims to reduce disputes, and surprise medical billing. However, like all changes, the Act is limited, and the aid of a professional insurance broker is strongly recommended. .
Laws and ethics regarding saving human life in an emergency situation are subject to constant revision and scrutiny, with both sides of the debate feeling equally defensive of their position. This turmoil, combined with the rampant capitalist growth, those with the ability to keep charging more, do.
As brokers, our job is to be as familiar with your state of affairs as we are with all the available coverage options, so we can offer you a protection plan without surprises.
The No Surprise Act
Simply put, it is illegal to charge patients out-of-network rates for emergency services, if the individual didn’t choose the provider, or are unaware that they’re not in-network.
The No Surprise Act also forces medical facilities and providers to explain potential healthcare costs clearly; and they’re compelled to charge in-network rates for most out-of-network services.
You don’t have to worry about Surprise Billing hiding around the corner anymore, but expensive hospital bills could be here to stay. Get in touch with us to see how we can help!