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State health insurance rates up, but many still lack coverage

If you go What: JRMC U Forum on Health Insurance When: 11:15 a.m. Thursday, Nov. 10 Where: Legacy Center, 419 5th St. NE, Jamestown Information: Admission is free. Professionals will be on hand to answer questions in private setting. rrr Dealing ...

From left, Alison Kennison, Victoria Rangel and Becca Klipfel pose Thursday, Nov. 3, at the Jamestown Regional Medical Center. The women work with patients to get the health insurance coverage they need. Katie Fairbanks / The Sun
From left, Alison Kennison, Victoria Rangel and Becca Klipfel pose Thursday, Nov. 3, at the Jamestown Regional Medical Center. The women work with patients to get the health insurance coverage they need. Katie Fairbanks / The Sun

If you go

What: JRMC U Forum on Health Insurance

When: 11:15 a.m. Thursday, Nov. 10

Where: Legacy Center, 419 5th St. NE, Jamestown

Information: Admission is free. Professionals will be on hand to answer questions in private setting.

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Dealing with an illness or an injury is stressful, and worrying about medical bills makes the ordeal worse. Alison Kennison, Jamestown Regional Medical Center patient financial services manager, said patients who are uninsured or not familiar with their coverage often end up with medical bills they didn't expect and cannot pay for.

JRMC has 20 to 25 patients per week who do not have health insurance, Kennison said.
The number of uninsured people in North Dakota decreased from 15 percent in 2013 to 6.9 percent in 2015, according to the Gallup-Healthways Well-Being Index. North Dakota is one of the top 10 states with the largest reduction of percentage of uninsured people, Gallup said.

The National Health Interview Survey states 9.1 percent of the U.S. population was uninsured in 2015. The number of individuals without coverage has decreased from 11.5 percent in 2014, the survey said.

However, that leaves 28.6 million uninsured adults in the United States and about 51,000 uninsured adults in North Dakota, the national survey said.

Kennison said from February to July 2015 the average number of self-pay cases per week was 34. Since implementing up-front financial counseling, the self-pay average has dropped to 18 per week for August 2015 to August 2016.

JRMC is holding a forum to help people understand their health insurance coverage on Thursday, Nov. 10. The event will begin at 11:15 a.m. at the Legacy Center, and is free and open to the public.

Kennison said local insurance agents were invited to attend and advise those attending. She said the goal of the event is to educate the public on their coverage, not to sell plans.

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"We want to be proactive rather than reactive," Kennison said. "Just because you have insurance doesn't mean you have the right coverage."

Victoria Rangel, JRMC patient accounts coordinator, and financial counselor Becca Klipfel work with patients to get them the insurance coverage they need, Kennison said.

"They really care about the patients," Kennison said.

Many patients don't understand how insurance works, Rangel said. Insurance plans with the cheapest monthly payments have the highest deductibles, and some people don't know what that deductible is until they have to pay it, she said. Kennison said generally speaking, 80 percent of JRMC patients have insurance plans with high deductibles.

"People don't understand what they are purchasing," Rangel said.

The beginning of health insurance marketplace open enrollment on Nov. 1 makes this perfect timing for the forum, Kennison said. The marketplace open enrollment is between Nov. 1 and Jan. 31, when people can enroll in a health insurance plan.

Rangel said although they can't tell people what the best insurance plan is, they can give patients tools to ask insurance companies the right questions.

Three companies are offering coverage in North Dakota's marketplace - Blue Cross Blue Shield of North Dakota, Medica and Sanford-with an average of 19 plans to choose from, according to HealthCare.gov.

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People can sign up for coverage outside of open enrollment if they qualify for a special enrollment period such as getting married, having a baby or losing other health coverage. Individuals can apply and enroll in Medicaid or Children's Health Insurance Program any time.

North Dakota is one of 31 states that expanded or is in the process of expanding its Medicaid program, according to Gallup. Medicaid expansion allows individuals or families to qualify for coverage based on income alone, rather than income, household size, disability, family status and other factors, HealthCare.gov states.

Rangel said some people don't realize they are eligible for Medicaid, or their pride prevents them from signing up.

"It's hard for people to come forward and admit they weren't prepared," Rangel said. "But Medicaid is there to help you, not to shame you."

There are also programs through the Affordable Care Act and JRMC to bring down medical bills for people who don't qualify for Medicaid. JRMC's Community Care Program provides total or partial discounts on medical services based on insurance coverage, income and medical necessity.

The Kaiser Family Foundation and New York Times Medical Bills Survey said 53 percent of uninsured adults had problems paying or were unable to pay medical bills in 2015.

"When you are sick, you need emotional wellness to get better, and if you are worrying about a huge medical bill, that's not going to happen," Kennison said.

Many patients don't get insurance because the process is overwhelming, and they don't think anything is going to happen to them where they would need it, Klipfel said. There is a population whose parents didn't have insurance, so they don't either, Rangel said.

If someone can afford health insurance but doesn't have it, he or she must pay a fee when filing for a federal tax return. According to HealthCare.gov, the fee is calculated as 2.5 percent of household income or a per person rate, the individual pays whichever is higher.

The maximum payment of the income percentage is the total yearly premium for the national average price of a marketplace Bronze plan. The set rates are $695 per adult and $347.50 per child under 18, with a maximum payment of $2,085.

Rangel said some patients don't have coverage because they distrust insurance companies or they'd rather self-pay than deal with the enrollment process. Rangel said when she or Klipfel approach a patient, some are resistant to their services.

"People think the bottom line is money," Rangel said. "Yes, we'd like to collect payment, but we're not a bill collector, we're there to help the patient get coverage so he or she doesn't have to pay out of pocket."

The health insurance and medical bill paying process can be like a large puzzle with missing pieces, Rangel said. Explanation of benefits is not always clear, and Rangel said patients will call the hospital asking about the actions of their insurance provider. She said they usually refer callers back to their insurance companies, but explain the terminology to use to get the right answers.

"The more people understand health insurance, the better they can ask the questions they need to," Rangel said.

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