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Thinkstock image / More and more consumers, in Chattanooga and elsewhere, are finding themselves responsible for larger portions of their medical bills, amounts that many are unable to pay despite having health insurance.
polls here 3538Christian Langford didn't really want to go to the emergency room at Hamilton Medical Center in Dalton, Ga., when he discovered he had a staph infection in his arm two years ago.

But his sister was worried the infection, a boil on his arm the size of a quarter, was getting worse. His doctor couldn't see him until the following day, so he felt he had no alternative.

The doctors at Hamilton took a blood sample, inserted an IV, numbed his arm and used a scalpel to remove the boil while he sat on the edge of a bed in the examination room, he said. They packed his arm in gauze and sent him home, telling him to make a follow-up visit the next day with his family doctor.

The bill for the visit was more than $3,800. Langford's health insurance paid $2,000, but he was still on the hook for another $1,800, money he says he just doesn't have, despite regular calls from a collection agency.

As Langford sees it, he and his wife paid some $5,600 last year for health insurance, through his wife's employer, and yet when he needed it, only $2,000 of his hospital bill was paid, because of his deductible.

"If my doctor had been in, this would have been a $15 copay," Langford said. "We work to pay for good insurance, and I still have to pay that out of pocket."

Langford is not alone.

More and more consumers, in Chattanooga and elsewhere, are finding themselves responsible for larger portions of their medical bills, amounts that many are unable to pay despite having health insurance.

"Health care costs have outstripped inflation, wage gains and the consumer price index, year after year," said Mark Rukavina, founder of Community Health Advisers, which advises hospitals on how to work with consumers to help them pay their bills.

Most Americans get their health insurance through their employers, and as those employers' costs have kept going up, they have passed part of that on to workers in the form of higher copayments or deductibles.

"The average deductible [on an employer plan] is over $1,300 per person, which is a lot of money," said Karen Pollitz, a senior fellow with the Kaiser Family Foundation, which researches health care costs. "High deductibles are becoming the norm."

According to the U.S. Centers for Disease Control and Prevention, in 2015 about 36 percent of insured U.S. residents were covered by high-deductible plans, compared with about 25 percent in 2010, with a high deductible defined as $2,500 for a family of four.

For those who don't get insurance from an employer, the deductibles are even higher. The average plan under the Affordable Care Act, a mid-level Silver plan, had a deductible of more than $3,000, while the cheapest plans at the Bronze level had deductibles of between $5,000 and $6,000.

But while the risk of facing significant health care costs is increasing, most people are not saving enough to cover their deductible. Separate surveys last fall by Pitney-Bowes and GoBankRate.com reported that around one-fourth of all Americans have no savings account at all.

"A lot of people spent through their savings getting through [the recession]," Pollitz said. "A $1,000 deductible or a $5,000 deductible will surely go beyond the level they have left."

CHI Memorial Hospital recorded $19 million in bad debts for the first five months of this fiscal year compared to the previous year, an increase of 34 percent, according to Troy Hammett, chief financial officer. Bad debts are defined as the failure to pay a bill by someone who earns enough money to be able to pay at least some of the bill, according to the hospital's calculations.

At CHI Memorial, that was offset by a decline in charity care, where the hospital writes off a debt to someone whose income is below the federal poverty level. But overall, the combination of charity care and bad debts rose by more than 12 percent, Hammett said.

WHAT CAN CONSUMERS DO?

Work with hospitals and doctors in advance to work out a payment plan, or find a way to save more money, health care experts agree.

"We have an exception now and then, but people want to pay their bills," said Britt Tabor, Erlanger Hospital's chief financial officer.

Erlanger will work with patients to figure out a way to make payments over time to pay a bill, Tabor said.

"I'd rather collect 90 percent than zero percent," he said.

"We work with patients on payment arrangements to try to get them to meet their financial obligations," CHI Memorial's Hammett said. "We do make some attempt to take that debt. But we won't ever take someone's home or force them into bankruptcy."

But often, it is hard for patients to know in advance how much they may owe.

"Our health care industry has grown up in such a way that it in no way, shape or form is friendly to a consumer who is buying services with their own money," said Dr. Larry Van Horn, executive director of Health Affairs at Vanderbilt's Owen Graduate School of Management. "We don't price things up front. All of health care is a bill after everything has been done."

Part of the problem is the very nature of many medical treatments — the doctors or hospitals themselves don't know up front what care will be required until they do examinations and perform tests and try various combinations of drugs and other treatment to see what works.

How much each of those items will cost depends on whether they are inside or outside the consumer's health insurance network, and on what deductibles or copays are included in their specific insurance plan, said Rae Bond, executive director of the Medical Society of Chattanooga, which represents area doctors. "It's very hard for anybody to find out what a health care service actually will cost," she said.

Once the bills start coming in, consumers can feel overwhelmed.

"When the bills get big, people just get overwhelmed," said the Kaiser Foundation's Pollitz. "You've got 100 bills sitting in a shopping bag on the dining room table, and you are too sick to open it up and look at it."

Many consumers facing high bills are also facing additional financial pressure because their illness, or the illness of a family member, means a loss of income if the patient loses a job or a mother, for example, has to leave her job to care for a sick child.

Ironically, the poorest consumers may be better off than those with a health insurance plan and high deductibles. Most hospitals have a charity care policy for patients who are below the federal poverty level. And there are often other sources of payment. The local medical society, for example, has provided some $139 million in free care over the past 12 years to patients with no ability to pay under its Project Access program, according to executive director Bond.

Experts say, over time, the high deductibles may force the health care industry to change, because they will pressure consumers to shop around for the lowest prices before spending their limited health care dollars, and they will force the health care industry to find ways to control costs. "That's going to inject some tension into the market to force the existing industry to create value for the customer at a price point they can afford," Van Horn said.

"We've gotten people addicted to the crack, that if it is health care, they don't have to pay for it, they are not accountable for it," he said. "The future is one where people are going to have to save, just like they do for all other things in their households, if they truly value it."

Consumers who are working have a couple of options.

Health Savings Accounts allow employees to put aside a portion of their salary to cover health costs they know they are likely to incur.

"For instance, I wear contacts or glasses, I know I am going to have to go to an eye doctor," said Erlanger's Tabor. "I can set money aside every year and pay those expenses out of there." And the money put into an HSA is not taxed.

About a fourth of all U.S. employers offer some form of Health Reimbursement Account, which allows an employer to put money into an account set up for an employee's health care expenses. But the employee only gets the money if he or she needs it to pay a medical bill not covered by insurance, and the employer gets a tax break for whatever money employees use.

That is little help for those whose employers don't offer the accounts, however, nor are the HSAs always workable for people who don't earn a lot of money and have many competing demands on their paychecks.

Ultimately, Rumanski said, "we've got to get a handle on health care costs."

Contact staff writer Steve Johnson at sjohnson@timesfreepress.com, 423-757-6673, on Twitter @stevejohnsonTFP, or on Facebook, www.facebook.com/noogahealth.

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