Aetna’s Claim Denying Lawsuit Puts Spotlight on Medical Bill Deb - WBCB: The Valley's CW |

Aetna’s Claim Denying Lawsuit Puts Spotlight on Medical Bill Debt in America


With the recent news of Aetna settling a multi-million dollar lawsuit that claimed a chronically ill patients medical bills were denied. And what some have said is an admission by one of their medical directors that he didn’t look at patients medical history’s when deciding to pay or not pay claims, I think we should talk about medical debt. It’s likely no surprise to most people that the majority of bankruptcies in this country are due to medical bills. What I was surprised to read a few years ago though is that of those that file due to medical bills, the vast majority have health insurance. Even when your carrier approves the claim, there are so many costs that health insurance doesn’t pick up. And even if you’re lucky enough to have most of your medical debt covered, there is still the everyday debt that can add up from lost pay due to missing work when ill or injured.

The dangers of medical debt

Despite conscious efforts by governments to reduce the cost of healthcare, a majority of persons, particularly in the US, still have to deal with one form of medical debt or another. In 2014, the Affordable Care Act became effective in the US. The Affordable Care Act was particularly aimed at making healthcare in the states more affordable. Partly because of the ACA, as many as 89 percent of people now have had insurance in some form the last few years, according to the Department of Health and Human Services. Unfortunately, it is noteworthy that, in the US, particularly among persons aged between their mid-twenties and mid-forties, there is notable medical debt which has significantly affected many peoples credit scores. Persons with significant medical debt have often taken to not checking their credit score until they get a sustainable form of income as a measure of coping with the associated stress. It’s said that Americans owe about $80 billion in medical debt.

Sources of medical debt

It is noteworthy that medical debt is found among the insured and uninsured. These debts are accrued from many ways, including the following.

Pre-ACA debts

Although medical debts are significant in the US, it has been established that a lot of medical debts persons struggle with were carried over before the ACA became effective. Seeing that healthcare needs are basic needs, getting healthcare services, even at a reduced cost, while paying past debts reduces one’s ability to clear off the old debts. This applies to both the insured and the uninsured.

Health insurance covers

Research has shown that medical debts, especially among persons in their mid-twenties is often attributed to the types of health insurance cover they buy. These covers, which they choose based on their financial stability and sources of income, often come with little protection. Thus, the out-of-pocket expenses made by this group of persons mounts up over time. In many of my experiences over the last decade younger people tend to be happy buying anything as long as it’s called health insurance and it has a low premium.

It has been noted that medical debts build up because insured persons, without prior knowledge get healthcare services from professionals outside the network of their insurance service provider. Such services are not covered by any form of network pre-arrangements made up by the insurance firm and come at a higher cost, contributing to accrued debts.

Unpaid claims

Medical debts can also arise when insurance companies refuse to pay claim as has happened in times past. The recent Aetna case noted above, where a patient was denied claims is one of the numerous examples of insured persons being denied healthcare services covered by their insurance package. Refusal to pay claims have been quite an unhealthy trend that has attracted attention in different circles.

Effects of medical debts

Individuals and families have had to cut down expenses on other aspects of their lives to continue to receive healthcare services. Individuals and families have been denied vacations, everyday family entertainment and in many cases some of the necessities of life because they had to cope with medical bills.

The quality of healthcare persons managing medical debts have received over time has declined and many people have resulted to skipping medical checkups and managing illnesses with over the counter drugs instead of visiting a doctor. Mental health consequences have also developed from medical bills especially among persons struggling with large medical debts.

Overall, globally, and especially in the US, there is an increased danger of increasing medical bills, especially on the quality of life. Now more than ever it’s essential that our governments enforce the insurance company’s obligation to pay their customers claims.

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