Let me be clear that my posting his response is not an endorsement of his opinion or anything he says within. I'm just sharing it because I think it is only fair to let readers see what turn out to be some valid objections to some of my previous statements.
*Quick note as promised: You comment early on in your post that you “don’t know of any doctor or hospital that would refuse to let a cancer patient make multiple smaller payments on a bill,” so her concerns about upfront affordability can be dismissed. (You wrote “by her, not us” but I’m assuming you meant “by us, not her.”) But if her previous plan covered a particular procedure, such as a regular schedule of bone marrow biopsies (which we’ll get into in further detail below), but it’s unclear whether her new plan will cover the same frequency of biopsies, she must either take the chance on a procedure that can cost in the high thousands or forgo it. Working out an installment plan with the provider, and the hospital, and the lab, assuming for the sake of argument that’s even as simple as you say it is, still leaves her deep in the hole. Which means this argument lacks merit with regard to demonstrating that AFP’s ad was misleading. I strongly question the assertion that we should ignore the perspective of the person paying the bills in a conversation about the affordability of those bills anyway. If she can't ignore her concerns about upfront affordability, neither can we.
Some states limit the amount that out-of-network hospitals and doctors can charge above what insurance has covered, experts said, but there are no federal curbs on balance billing. The new health care law, does, however, offer some protections for people who need emergency care: insurers cannot charge more for co-payments and co-insurance for emergency services than they would charge when you use in-network providers. Insurers must also pay out-of-network emergency providers according to a standard schedule, in hopes of lessening the likelihood that patients will be left with enormous bills. Still, there’s nothing in the law that stops health care providers from billing consumers for the balance, which is what often happens — and exactly what the D’Andrea family experienced. “This is not an issue that the Affordable Care Act fixes,” said Timothy S. Jost, a professor at the Washington and Lee University School of Law and expert on health care laws. “It is conceivable that the problem gets worse for some people if the Affordable Care Act encourages narrower networks, which some people think it might do.”
As a Blue Cross Blue Shield representative patiently explained to me, however, the out-of-network limit isn't really a limit. When a customer reaches that amount, the insurer will still pay only the standard out-of-network share. That's why my plan covered only 50% of the $54,755 charged by Tristate Care Flight to ferry me (by helicopter) from a car wreck in Quartzsite, Ariz., to a hospital in Phoenix. If Tristate wanted to bill me for the other half, the representative explained, it was free to do so.
The healthcare law's out-of-pocket limit suffers from the same shortcoming. Once you reach it, your insurer will cover 100% of the cost only of the essential health benefits covered by the plan, and out-of-network services are exempt (except for emergency treatments). That's a troubling thought, considering how many insurers are reducing the number of doctors and hospitals in their plans. These ‘narrow networks’ increase the chances that a doctor, therapist or clinic you'd like to use won't be subject to the annual cap.
More ominously, being treated at an in-network hospital is no guarantee that the specialists who see you there will be in your plan's network as well. If there's no emergency involved, you could be stuck paying the difference between the contracted amount and the specialist's charges, even if you've hit the out-of-pocket limit. And the difference can be staggering: In one extreme example cited by the insurance industry, an out-of-network California pathologist charged $8,100 for a tissue exam for which Medicare reimburses $128.