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What health insurance doesn’t cover

February 12, 2020, 2:18 AM UTC

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Hello, readers.

It’s understandable when the back-and-forth over Medicare-for-all (aka single-payer) gets the lion’s share of the media spotlight. After all, the idea of reforming the American health care system root and branch is, to put it mildly, massive.

But it’s important to recognize the underlying problems driving the intense debate about American health care policy. Surprise medical billing ranks high on that list. “The way we finance health care promotes economic inequality,” Dr. Adam Gaffney, president of Physicians for a National Health Program and an instructor at Harvard Medical School, told ProPublica.

Say your doctor sends you to the local hospital to see a specialist. Or you get hurt and end up getting checked in because you need immediate surgery. Seems like, in both cases, the doctor and the hospital would both be covered by the same insurance policies, right? Wrong. It’s actually pretty common for an insurance company to deny one or the other. And, depending on your circumstances, that may lead to an enormous medical bill laid on your lap.

Don’t take my word for it. A new study published in the journal JAMA outlines just how common these out-of-network bills can be. Turns out more than 20% of the people the researchers studied had been hit with an unexpected bill. And, depending on the study, between 79 million and 137 million Americans have had problems with medical debt. In some places, not paying the bills can upend a person’s life in very surprising (and pretty horrific) ways.

Lawmakers appear to agree that this is an issue worth addressing. Whether that results in anything remains to be seen. And, if anybody you know just scoffs and says people need to take care of their medical costs, tell them that the surprise is also on them.

Read on for the day’s news.

Sy Mukherjee


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