You pay your monthly insurance premiums. You double- and triple-check to see that a local provider is in network. You ascertain that a certain medical service has a set copay. You go to the provider for the service and pay the copay.
Three weeks later, you receive a bill from the hospital or provider. The bill lists the service you received along with several “sub-services” you did not know you received. The bill does not list your copay but has several additional fees and codes you do not understand.
You call your provider and insurance company and ask them what is happening. Three responses are typical:
- The “sub-services” were not covered and you will have to pay for them out of pocket (but you did not ask for any “sub-services” and were not informed of them beforehand).
- They will look into it and get back to you (but the claims department is backed up and can’t tell you exactly when they will get back to you).
- The doctor you saw that day was not in network and, therefore, you have to pay the out of network price (but you had made it clear you wanted an in network doctor from an in network provider).
Depending on the situation, you pay the extra fees to avoid missing a deadline or having your credit affected. Or, you begin a monthslong fight. Throughout the ordeal, you wonder why healthcare costs and fees are so mysterious.
As your delegate, I will work to ensure the patient/provider/insurer relationship is transparent and understandable. I will seek to codify plain language that will require costs and fees of medical services to be communicated upfront and fully before and after they are provided. We expect nothing less from consumer transactions. How much more with our healthcare.
To further improve our healthcare, I will work alongside experts to investigate how highly-skilled immigrants might more efficiently become licensed dentists, doctors, and nurses without sacrificing our world-class standards. My wife practiced medicine in Brazil and the U.K., and she affirms U.S. standards are the best she has seen. Having had three ACL surgeries, I know the importance of having highly-trained medical professionals to get you back in the game.
Finally, I will encourage employer-matching health savings accounts that will promote personal responsibility for individual and family well-being. If needed, these accounts could be shared with additional family members with chronic illnesses and pre-existing conditions.