Only half of Coloradans are confident they can find out the cost of health care services in advance or fix an incorrect medical bill, according to a new poll that reflects longstanding concerns about the complexity of the system.
The Consumer Healthcare Experience State Survey, which included about 1,400 Colorado adults, found four out of five were confident they could follow medical instructions from a doctor. But the group was significantly less sure about the financial side of seeking care.
About 55% of those who responded believed they could choose the right insurance plan for themselves. Roughly half thought they could dispute an incorrect bill, find out what a procedure would cost them ahead of time or fix a problem if their doctors weren’t responsive to their concerns.
The major players in health care purposefully created a system that average people struggle to navigate, suggested Mannat Singh, executive director of the Colorado Consumer Health Initiative, which wrote about the findings.
The CCHI has a team of experienced people who help patients challenge incorrect bills, but even they have to research and figure out the nuances each time, she said.
“The system is deliberately convoluted and opaque,” Singh said.
In the survey, respondents’ confidence was even lower when it came to believing they could prevail against a hospital or insurance company; only about two out of five thought they could fix a problem if either entity didn’t want to work with them, according to the report.
The survey, conducted by the Altarum Healthcare Value Hub, recruited participants online. While it roughly matches Colorado’s racial and income demographics, people who opted to participate may be more interested in health care affordability than the general population.
When it comes to finding prices, Coloradans may have underestimated themselves. When asked if they’d succeeded in finding out the cost of a service they needed in advance, between 59% and 76% of those who’d tried to do so said they learned what they needed to know. People who needed a prescription or a primary care visit had better odds of figuring out their costs ahead of time than people who expected to stay in a hospital or see a specialist.
Still, a significant fraction of people said they were too confused or overwhelmed to even try to figure out prices. Between 13% and 21%, depending on the service, didn’t attempt to find that information before receiving care.
Colorado has done more than some states to try to make pricing information accessible, including limiting how aggressively hospitals can pursue patients for payment if they don’t post their prices. The state also recently unveiled a new transparency tool.
While hospitals are posting prices, the information often is incomplete and confusing, Singh said.
Respondents in the survey also reported widespread confusion about how their insurance worked. More than three-quarters could define a co-pay (a flat amount they pay out-of-pocket for a service), a premium (the monthly cost to maintain coverage) and a deductible (the amount they have to pay out-of-pocket before certain benefits kick in).
But 56% were stumped about co-insurance, which is a percentage of the cost of a hospital stay or other service that they have to pay out-of-pocket, rather than a flat amount. Only half of people with graduate or bachelor’s degrees knew what co-insurance was, and the odds of defining it correctly dropped for people with less education.
Coloradans also appeared unsure about what they could do if they received a surprise medical bill.
About half called their medical provider or insurance company, and one in five attempted to negotiate a lower amount. Fewer than 10% tried to get help from a consumer advocacy group or a state agency or filed a formal appeal with their insurer. (The categories weren’t mutually exclusive, so a person may have tried multiple tactics.)
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Less than a quarter of people who received a surprise bill said they had resolved it to their satisfaction, while a third said their bill still wasn’t resolved and the rest said the process was over, but they weren’t satisfied.
About 55% of people who received a surprise bill said they paid the full amount, either all at once or via a payment plan. Another 20% succeeded in getting the bill lowered or written off. And 5% saw the bill go to collections. The rest said they still were in the process of resolving it.
Many people don’t have the time, knowledge, or mental bandwidth to challenge a bill, even if they know it’s wrong, Singh said. Additionally, they often fear their debt will go to collections or that their health care provider will punish them in some way if they don’t pay up, she said.
“The onus should not be on the consumer to fight,” she said.