While the percentage of Americans who lack health insurance has dropped significantly in recent years due to the Affordable Care Act, many of the newly insured have high-deductible plans that still leave them with big hospital bills they can’t pay.

The trend towards high-deductible plans is worrisome not only to customers but to hospitals, which have experienced an increase in the number of insured patients who aren’t able to pay what they owe for services.

“(R)ecent findings indicate that very high-deductible plan customers may pay at a rate more similar to that of uninsured patients," says Brian Sanderson, managing principal of the health care services group at Crowe Horwath LLP, which recently conducted an analysis of the way in which hospitals determine which bills will most likely be paid.

The higher the bill, the less likely a patient with a high-deductible plan is going to pay all or some of it, the analysis finds. For instance, the hospital is more than four times as likely to collect payment for a balance of more than $5,000 from a patient with a low-deductible health plan.

More specifically, the payment rate for balances between $1,450 and $5,000 is only 25 percent for those with high-deductible health plans. That decreases to 10 percent for balances between $5,000 and $7,500, 4.1 percent for those between $7,500 and $10,000. For bills greater than $10,000, the payment rate is a measly 0.9 percent.

Traditionally, the report notes, hospitals have only distinguished between insured and uninsured patients in their payment portfolios, with the recognition that collecting from the uninsured patients will likely be much more difficult. However, due to the big differences in payment rates based on the type of insurance, Crowe suggests that they begin to distinguish between patients with high-deductible plans and those with low-deductibles.

“Parsing accounts based on patient balance will prove a particularly insightful analysis for any finance team and likely will create a more reliable collectability factor based on historical experience,” it concludes.

Another major factor that hospital leaders have blamed for poor payment rates is the trend towards health plans with narrow networks. Because many plans, particularly those purchased through the ACA exchanges, do not include a broad network of physicians and specialists, many insured patients are going to the emergency room for basic care, according to a 2015 report by the American Academy of Emergency Physicians.

Instant Insights /

High deductibles blur line between insured and uninsured

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