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Three Health Care Trends Could Mean Rising Costs for You

Lifesaving medical advances, new technologies and groundbreaking experimental treatments are splashed across front pages and TV news every day. Unfortunately, the latest lifesaving trends...
February 16, 2005

Catastrophe Major Medical Insurance Plan Can Help

By Joan O'Sullivan
Managing Director, Marsh Affinity Group Services
PIA Services Insurance Program Administrator

Lifesaving medical advances, new technologies and groundbreaking experimental treatments are splashed across front pages and TV news every day.  Unfortunately, the latest lifesaving trends aren't the only ones making headlines these days.  Other developments have made some quality care harder for many Americans to afford, no matter how solid their basic health coverage may seem.  Here's why:

Trend #1: Out-of-pocket costs, such as co-pays, continue to increase for many health plans.

Some health plans are struggling to keep up with the costs of new technologies - and raising your out-of-pocket expenses to compensate.  This usually isn't a problem when you need routine care.  But if you have a serious illness or injury, you may need to plan to pay more yourself.

Trend #2: Hospital stays are getting shorter, and home recovery expenses are increasing.

More patients are recovering at home as hospital stays shorten. For example, the average hospital stay for a heart attack in 1993 was 7.4 days. Today, it's 5.5 days. While this trend can reduce your overall hospital costs, you may have more home health care costs.  Unless you're gravely ill and in the hospital indefinitely, you can expect to spend your time recovering at home, paying a greater share of the cost yourself.

Trend #3: No health insurance plan is designed to cover everything.

Many regular health plans, including Medicare, now focus more on covering routine and preventative care.  While this is good news because it helps you get early diagnosis and treatment, comprehensive coverage for serious injuries and illnesses is harder to find under most basic plans.  Without extra protection in place, you may have to pay more out of your own pocket to get the care you want.

You could use money from savings or retirement to cover your share of your medical bills … or turn to your children for help. Or, if you're like many Americans, you could consider additional health insurance, like PIA Services' Catastrophe Major Medical Plan. This plan provides additional medical care benefits after your basic plan benefits have been exhausted, provided your deductible has been satisfied.

Catastrophe Major Medical Plans: Extra Coverage in the Hospital

Catastrophe major medical insurance is designed to help with medical expenses beyond the limits of your basic health insurance. Because basic medical insurance has limits that can be quickly reached if you have a serious accident or illness, catastrophe major medical insurance plans are specifically designed to take over where basic health plans stop.

For example, some health plans don't fully cover expenses like Private Duty Nursing Care. Private Duty Nursing provides full-time, one-to-one care from a nurse focused on you - someone who has comprehensive knowledge of your needs - rather than a nurse overloaded with many patients to care for.

Also, some basic health plans limit the recovery care expenses they'll cover to charges they consider "reasonable and customary."  In other words, the usual charge for a specific procedure or service in your geographic area. For example, say your doctor charges $5,000 for a surgical procedure and your basic medical plan only considers $3,000 to be "reasonable and customary" for that procedure.  In many cases, the plan won't pick up the difference.

Finally, most health plans won't cover medical expenses they don't consider "medically necessary."  Since all plans don't define "medically necessary" in the same way, you may be surprised to find extra charges on your hospital bill that your health plan wouldn't cover … because they didn't fit the plan's "medically necessary" requirements.

Catastrophe major medical health plans not only help pay for charges above and beyond your regular coverage while you're in the hospital - but they also help out when you're recovering at home.

Extra Coverage at Home

Because more patients are spending less time in the hospital and more time recovering at home, solid coverage for Home Health Care, Home Nursing Care and Convalescent Home Recovery expenses is becoming a big concern for many patients.

Many plans limit the home care they'll pay for.  Depending on how much you're willing to pay for yourself, this could restrict your home health options to less than what you need.

A Catastrophe Major Medical Plan can help cover your home health expenses - and ease your financial worries during a time when you should be recovering, not struggling with bills.

For More Information

Here is your chance to secure this valuable protection. Designed specifically for its members, the plan offers you exclusive benefits and economical group rates.

This plan is subject to the terms, conditions, exclusions and limitations of the group policy. For costs and complete details of coverage, visit the PIA Main Street Store's Catastrophe Major Medical Plan web page here on PIANET or contact the plan administrator toll-free at 1-800-503-9230. Coverage may vary or may not be available in all states.

"AHRQ Data Show Rising Hospital Charges, Falling Hospital Stays." Agency for Healthcare Research and Quality (AHRQ). Available:

PIA Connection

This article originally appeared in the January 2005 PIA Connection.

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