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Health Care Reform:

Health Insurance & Affordable Care Act

Patients Struggle to Learn Health Insurance Lingo

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“There is a huge void,” said Bonnie Braun, a health literacy expert and professor at the University of Maryland School of Public Health.

Insurance is often perplexing even to savvy consumers. Acronyms abound: HMOs, PPOs, ACOs. Letters arrive in the mail saying “this is not a bill” yet appear to be just that. Some detail exorbitant prices that have nothing to do with what is actually owed.

Language and cultural barriers add to the confusion. “It’s hard to understand even if it is Spanish,” said Marisela Sanchez, 50, a new Medi-Cal enrollee from Los Angeles who has diabetes, high blood pressure and high cholesterol. “If it’s in English, it’s worse.”

Community health centers throughout the nation are seeing some of the problems firsthand.

At Eisner Pediatric & Family Health Center in downtown Los Angeles, lead enrollment specialist Martha Vasquez said the vast majority of patients who bought private insurance selected plans with the lowest premiums, not necessarily grasping that those plans came with high deductibles.

Now they are asking why the visits that they consider preventive aren’t free and whether hospital visits are included in their plans.  They also are uncertain what specialists they can see and what medications are covered.

Jessie Yuan, a physician at the center, said patients have been confused about health insurance for a long time. The new health law “just adds another layer on top of that,” she said.

Yuan said she sees it as part of her job to give a brief orientation to new Medi-Cal patients. On a recent morning, she spoke with Oscar Gonzalez, a diabetic patient from Huntington Park, in Spanish. Gonzalez had been switched to Medi-Cal from a free county program for the uninsured.

With Medi-Cal, Yuan told her patient, over-the-counter medications like Tylenol and cough syrup aren’t free anymore.  He can get a free vision appointment but will have to pay for glasses. It will be easier to get referrals to specialists, but if he needs to change the appointment, he has to do it himself.

Sat, Jun 14 2014

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