Nov. 27--Physician practices and hospitals say they're feeling the effect of rising insurance deductibles, which are making patients responsible for a bigger portion of their medical bills.
Consider this: In 2003, no state had an average deductible exceeding $1,000 for an individual policy, according to a 2015 report by the Commonwealth Fund, a New York foundation focused on health care policy issues.
That's no longer the case.
Deductibles have doubled in the last decade in all but six states, Commonwealth reports. In 2003, the average deductible in the U.S. for an individual with employer-based coverage -- at a firm with 50 or more employees -- was $452. By 2013, that number had climbed to $1,169, an increase of 159 percent.
In Missouri, the increase was even more pronounced: The average deductible for an individual with employer-based coverage rose from $384 in 2003 to $1,289 in 2013. That's an increase of 236 percent.
High deductibles are common on plans offered on the government-run health insurance exchanges. Starting Jan. 1, those enrolled in individual plans through HealthCare.gov will find that some plans have deductibles that are nearly $7,000 for an individual.
Many consumers accept high-deductible plans because the premiums are more affordable -- or because they have no other choice. But if they require medical services, they discover they're on the hook for a substantial portion of the bill -- more than they may be able to pay.
"For many people the deductible is larger than the amount of money they have in the bank," said Cathy Schoen, health care economist with the Commonwealth Fund.
The service providers, not the insurance companies, are the ones stuck with trying to collect the unpaid balances.
As high deductibles have become the norm in recent years, frustration has boiled over at Signature Medical Group, the largest independent physician organization in the St. Louis area.
Nancy Glass, who leads the group's billing department, said it may take them one to two years to collect on bills for surgical procedures that insurance companies used to pay in under one month.
"We literally have millions of dollars that are sitting out there," Glass said of uncollected medical bills.
The problem, she said, stems from patients not understanding the type of medical insurance they have, and opting for lower premiums, unaware of the high deductibles that are attached to these plans.
"Plans aren't explaining that if you take this plan, you only have to pay $100 per month but it has a $3,000 deductible," she said.
It has led her organization to start collecting bills before rendering services in some cases. In 2014, her group started charging for MRIs upfront because it's a procedure that typically goes toward a patient's deductible, she said.
But Signature is not alone. Other organizations are trying to come up with creative ways to entice patients to pay lingering medical bills.
SSM Health, one of the area's largest hospital operators, which recently acquired St. Louis University Hospital, also recognized high-deductible plans were becoming a source of financial stress for patients.
Just last year, SSM began offering a 25 percent discount to patients who paid in full before a particular procedure. Patients are also eligible to receive a 15 percent discount if they pay in full within 30 days after a procedure. System officials call it the "prompt pay" program and say it has helped the collection process.
"They have enough worries on their mind, they should not be worried how much their bill will be when their services will be done," said Paul Sahney, vice president of revenue management for Creve Coeur-based SSM Health.
SSM also began partnering with Commerce Bank to offer interest-free loans with two- to five-year terms to help patients pay off medical bills.
Andrew Johnson, senior director of accounts receivable for Washington University Physicians, the doctors affiliated with BJC HealthCare, said there has clearly been an increase in billing costs.
"We're producing a lot more bills for people," Johnson said. "We're also having to do more financial counseling to help find people an adequate payment plan."
Elsewhere, it has started to clamp physician compensation.
From 2012 to 2014, bad debt at Esse Health has gone up 30 percent on a per physician basis, Dave Kearney, chief financial officer, said.
"It will move physician compensation down a little bit," Kearney said.
The issue of high deductibles has forced the organization to start a process of figuring out how to better handle these types of plans. Right now, there is an entire team dedicated to looking at the collection process to figure out better solutions. One thing the group has done is send more bills to collection agencies, he said.
Samantha Liss -- 314-340-8017
@samanthann on Twitter
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