Having Insurance Does Not Make Care Affordable

July 20, 2017
Jonathan Leffert, MD

A physician receives a hefty out-of-pocket medical bill and ponders what other patients in his situation are forced to do.

Recently, I went to my physician with left sided hearing loss, which I had been suffering from over the last several months. After appropriate auditory evaluation, I was diagnosed with unilateral high frequency sensioneural hearing loss. This prompted a diagnostic workup which included an MRI of the head with internal auditory canal evaluation for a possible acoustic neuroma. Because of my high deductible $6000 insurance plan that had not been met, and the cost of the MRI at over $3200, I was responsible for the entire bill. This test is the standard procedure to determine an important cause of my symptoms, and was perfectly appropriate for my care

My financial situation allowed me to pursue this evaluation, and as in many cases, a structural cause for my hearing loss was not found. However, for many people, the financial burden of $3200 might be prohibitive or require significant resource reallocation. What do people do if they cannot afford the out-of-pocket lump sum cost for a diagnostic test or treatment?

The obvious answer is that the test or treatment is not done, and the patient is not diagnosed. Insurance does not equal access, when the out of pocket cost is so high that the patient is unable to proceed with the workup. I cannot think of a more frustrating situation than paying insurance premiums, and having to meet a large deductible with an out of pocket cost that is unaffordable. Although deductibles are known at the time of the purchase of the insurance, like any unexpected cost in a fixed budget, getting hit with a bill for $3200 represents more than many people can afford at one time.

What is the solution to this significant barrier to care? I have not studied this issue in any detail, but I would guess this circumstance happens most frequently in diagnostic testing and with newer medications. Patients must be able to access care, particularly if they have insurance, or why have insurance in the first place? We have priced a certain group of patients out of the market, and as those numbers of patients grow, we will have many patients who paid for an insurance card but are unable to receive medical care.