High deductible insurance plan leads to a $2,200 bill for a finger infection
Deb Milostan is a part-time Bonita Springs resident who was fortunate enough to retire early. Since she was too young for medicare, which is insurance primarily for people over 65 years old, she had to buy her own health insurance for the first time at 62 years old.
“My main concern was making sure I was going to be covered in Michigan and in Florida,” she said.
But after heading to the Naples Community Hospital emergency room for a very minor emergency, Milostan found out the hard way she did not understand the coverage she purchased.
Milostan was paying monthly premiums of $720 a month and assumed she’d have a small copay when she went to the ER last January.
But the emergency, a swollen finger she accidentally shut in a door, ended up costing more than $2,200.
Her insurance was a high deductible insurance plan, which meant she was responsible for everything out of pocket until she reached $6,600.
Individuals shopping for insurance on the affordable care marketplace in Lee County will find similar premiums and deductibles.
According to the Kaiser Family Foundation, the average premium for someone making the median income in Lee County is around $500 a year.
For 2020, the government allows out of pocket costs for insured to be as high as $8,150.
Dr. Victor Claar, an economist at Florida Gulf Coast University, said this is an example of why the insurance industry was in favor of the Affordable Care Act.
The law does not encourage competition according to Claar which leads to the high premiums and deductibles.
“Why do I even have insurance?” Milostan said.
In her situation, NCH would have billed her more if she was uninsured. Her bill for an x-ray, and the nurse practitioner who drained fluid from her finger was more than $5,000.
But because NCH had a contracted discount with the insurance company, Milostan was only responsible for $2,200.
She’s been paying it off in monthly installments.
As of this year, she is eligible for Medicare and no longer insured through the affordable care marketplace.
NCH declined to do an interview with WINK News for this story.
A spokesperson said by email that a clinical team reviewed the circumstances and determined that the appropriate care was provided and that the cost was appropriate given Milostan’s level of insurance coverage.
NCH’s marketing coordinator, Shawn McConnell, also issued the following statement:
“NCH is, and always will be, patient-focused. We are committed to following standard hospital billing practices. Our financial services department assists patients with understanding their charges, as well as reviewing what their insurance coverage provides. Patients with balances due resulting from limited or no insurance coverage may be eligible for financial assistance programs and our financial counselors work closely with those who qualify.”
WINK News will be taking an in-depth look at our medical system for the next year. If you have a story you want to be heard, whether it’s a high medical bill, an insurance dispute or a medical procedure gone wrong, send us an email to [email protected]