Yahoo Finance Health insurance execs: 'We need to take a hard look at billing practices'
Two West Coast-based nonprofit health insurers — SCAN Group and CareOregon — recently announced a joint effort to help pay off medical debt in their regions. But the leaders of both companies acknowledge it isn't enough to impact the burden of health care costs on the American population.
The problem will only be solved, the company CEOs told Yahoo Finance in a recent interview, when insurers and medical care providers unravel the country's knotty billing system.
"We've normalized the abnormal. It is not normal in most countries for medical care to be something that you fear because it will put you in debt from which it's impossible to recover," said SCAN CEO Sachin Jain.
In the US, 23 million people are affected by medical debt, according to a March 2022 analysis by Kaiser Family Foundation. Over the years, news coverage of sky-high surprise bills has led to new laws to help curb costs and regular reporting of astronomical hospital bills has forced entities to forgive or reduce payment amounts.
But the problem of medical debt persists.
New York-based RIP Medical Debt, said in a June 2022 letter to CMS, that science shows medical debt can also negatively impact a person's physical health.
"When individuals carry medical debt, they are less likely to seek health care due to fears about cost and are more likely to use substances and struggle with mental health... [and] delay key life decisions ranging from saving for retirement to attending school," the nonprofit's CEO, Allison Sesso, wrote. "Medical debt ripples through families and communities and disproportionately affects people of color further exacerbating the racial wealth gap."
RIP was launched in 2014 and has attracted funding to help address the issue. The company uses donations to help purchase medical debt in bulk at a steep discount in order to pay it off. To date, the company has helped more than 6 million individuals and families and paid off more than $9 billion in medical debt.
SCAN and CareOregon are the two latest entities to provide some aid. They are funding medical debt relief through a one-time $345,000 grant, which will be used to clear $110 million in medical debt for nearly 70,000 individuals in Arizona, California, Nevada, Oregon, and Texas, according to the companies in a statement.
The leaders of both nonprofit insurers, which are in the process of merging, said the one-time grant isn't enough and systemic changes to medical billing are needed to really solve the problem.
Jain told Yahoo Finance he is hoping the health care system will "look more broadly at its billing practices, its collection practices, and its pricing and focus on transparency, and start to rethink some of that. I don't think the industry has paused to look at its own morality...or amorality."
He added that if small- to medium-sized companies like SCAN and CareOregon can help retire debt, then the large ones can do so "before it gets to the level of collection."
Insurers have been criticized for quick denials of coverage, forcing patients to learn self-advocacy and negotiate with payers, while hospitals have been criticized for aggressive debt-collection strategies and only backing down when the issue goes public or the patient negotiates.
But not everyone knows how to or has the time to sit and argue with insurers or hospitals, Jain said.
SCAN is a provider of Medicare Advantage health insurance and medical services including a physician group. CareOregon provides Medicaid and Medicare Advantage coverage, as well as operates a dental care service.
CareOregon CEO Eric Hunter said he knows he is part of a broken system and "an industry that has increasingly come under fire for doing anything it can to make as much money as it can."
Despite the good karma earned from taking on the expense of paying off the debt, there is no major business upside for the companies.
Paying down the medical debt of patients in their coverage area is "not something we will get credit for when the state does rate setting," and it may not drive an increase in membership, Hunter told Yahoo Finance. "But it has a positive impact on the entire population."
"We try to do what's right regardless of what the motivations of the other actors in this sphere are. Quite a bit of what happens in health care, and society in general, is performative," he added. It's why taking a hard look at transparency in pricing for things like ambulance bills and hospital bills would alleviate people getting into debt in the first place, Hunter said.
He added: "We have to take a hard look at what's happening....and start to affirmatively say, 'We don't think this is acceptable anymore.'"
Follow Anjalee on Twitter @AnjKhem
Click here for the latest stock market news and in-depth analysis, including events that move stocks
Read the latest financial and business news from Yahoo Finance
