High-deductible plans can have a significant impact on patients’ health care decisions and physician reimbursement, noted ACEP President L. Anthony Cirillo, MD, FACEP. “Many patients only find out how much they are responsible for only when they actually need their ‘coverage,’ only to find out that they don’t have ‘insurance coverage’ until after they meet their deductible payments,” Dr. Cirillo said. “When a patient can’t afford to make these payments, it’s the physician who ends up not being fully paid, even though they provided care at the time of the patient’s need.”
Experiencing the System From the Other Side
One emergency physician interviewed for this article experienced those financial pressures firsthand after being struck by a car while jogging last year. Because of privacy concerns, identifying details are being withheld.
The physician suffered a traumatic brain injury, multiple fractures, and spent weeks hospitalized and in rehabilitation; the bills arrived before the recovery did.
“One of the first things that pinged me was MyChart asking for payment while I was still in rehab,” the physician said. “I still had a C-collar on and couldn’t move either arm.”
Because the injuries involved an automobile accident, billing became entangled between health insurance and the driver’s auto insurance. Months later, hundreds of thousands of dollars in bills remain unresolved.
“It became this strange stalemate,” the physician said. “Everybody basically said, ‘If you get money from the driver’s insurance, we get paid first.’”
Then, in January 2026, the deductible reset while rehabilitation was still ongoing. Physical therapy visits that had been manageable suddenly cost several hundred dollars each.
“That dramatically changed how I felt about continuing therapy,” the physician said. “Every visit suddenly felt like losing $300 to $500.”
Eventually, the physician began skipping appointments.
“Even I started avoiding care,” the physician said. “You immediately understand how an average American family would avoid care entirely.”
The experience also exposed how overwhelming these systems are for anyone without the knowledge to navigate them.
“I’m highly educated and understand how these systems work,” the physician said. “If this was overwhelming for me, I can’t imagine what it’s like for someone who doesn’t understand insurance terminology or know how to advocate for themselves.”
The physician now discusses lower-cost alternatives with patients whenever possible, directing them to purchase durable medical equipment online rather than through the hospital, where markups can be steep.
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