Posted on 11/19/2017 7:32:51 AM PST by Elderberry
Pettit doesn't remember the five-minute drive from his house in Webster to Clear Lake Regional Medical Center or the sprint through the emergency room doors. He wasn't wearing a shirt or shoes, and his chest was turning red from where he pressed Ava's torn face against his body.
He fished out his Aetna card. "I'm at a hospital that is in my network. Everyone who's in this building should be in my network," he thought. He and his wife had picked that hospital because of their coverage. "It didn't occur to me it could be any different."
Then the bills from out-of-network doctors began to roll in.
Pettit, like so many others in this country, had tumbled unsuspecting into a multimillion-dollar business practice called balance billing. The murky system allows doctors outside a patient's coverage network to set higher rates and then shift any or all of the "balance" not paid by insurers onto patients to make up the difference.
It happens most often in emergency care, where vulnerable patients have no way of knowing in advance who will treat them. Often they find out too late that just because the hospital is in-network does not mean the doctor will be, too.
(Excerpt) Read more at houstonchronicle.com ...
This is true. It happened to me.
Why not make it clear (in writing) when you enter the hospital that NO out of network providers are are authorized to work on you?
The whole medical pyramid scheme is a fraud. Patients are the LAST thing on the list. Between Big Pharma, the AMA, hospitals, doctors, insurance companies and regulations we are the pinball rolling around getting battered every which way.
Wouldn’t this shut down the “balance billing” scam?
Often when you enter through emergency a person is not in condition to make a deal like that.
Also, as I found out, nobody seems to know which doctors are in or out of network at any time. They come and go.
One of the fun things about Obamacare. /sarc
“Why not make it clear (in writing) when you enter the hospital that NO out of network providers are are authorized to work on you?”
You’ll likely die waiting for an in-Network physician to happen along.
L
This crap happens all the time.. If it’s not the doctor who’s not ‘in-network’, it’s the lab, or the anesthesiologist.
To me, the way to fix this is get rid of all networks. Insurance company gives you a card like a credit card and the provider bills against it - then you take up any differences with the insurance company..
And have the providers post their rates so people can comparison shop.
“Often when you enter through emergency a person is not in condition to make a deal like that.”
Write it on the back of your insurance card...
It is a feckin’ tragedy what insurance companies, and even the medical institutions, have done to Americans.
The same is true with anesthesiologists. You won’t be told ahead of time who the anesthesiologist will be so you cannot, ahead of the surgery, decide on one who is in network. Suddenly, you’re on the hook for hundreds of dollars because your surgery was paired with a non-networked anesthesiologist.
I’ve had three surgeries in the past seven years and, each time, I was not allowed to know who the anesthesiologist was so I could investigate if I was covered and, in all three, I was not.
This is one of the many ways that taxpaying Americans get to pay for the healthcare of illegal immigrants.
Until free enterprise principles are restored to the medical system, it will continue to spiral out of control.
This happened to me. Twice. The ER docs were not in-network at the hospital that was in network. I fought with my insurance company and the doctor billing department. Eventually, the doctor billing took the payment from my insurance company and wrote off the rest.
If I have anything to do with it, we will no longer go to that facility even though it is closest. Meaning that if an ambulance takes me there I’ll have to deal with it. But we won’t walk in there willingly next time (hoping there won’t be a next time).
it’s why insurance is such an unneeded thing, largely a scam of a thing to have sold and now be mandatory.
If it got back to patients paying doctors/hospitals directly and doctors and hospitals charged reasonably it would all be simpler and work better. Just as people pay for anyother sort of business or service they need, you pay cash, credit, installments. cut out insurance middle men and frivolous law suits.
I hope you mean "/sarc" because this mess has taken more than 70 years to create. Obamacare just did something that I would have thought would be difficult, if not impossible. It made it worse.
In the case of a facial laceration in a young girl, of course the ER doc is going to call in a plastic surgeon because he doesn't want to get sued, and of course the plastic surgeon isn't going to accept most insurance assignments because he likes to get paid. Our insurance (I think) pays 80% of "out of network" claims. I haven't checked recently so GOK what it does now.
Me too.
that WILL be ignored in an emergency room. They have to take you. There are signs everywhere in ERs saying advance directives will be disregarded in the ER too.
No politician dares to accept the 20% hit to GDP that will occur as the current system is dismantled and replaced. Yes, it would be a huge improvement for everyone five years down the road, but that is cold comfort to the politicians and bureaucrats who will lose their jobs in the interim. :)
The second time it happened to me, I did a little research. The ER doctor who saw me, did nothing but call my ENT doctor to come to the ER to treat me at 10pm, and he lists himself as an ER doctor and nothing else, with an address for the hospital where the ER is.
So, I would assume that among the high prices on the ER bill, his costs would have been included. They were not.
I called my insurance company to complain. The people I spoke with told me they were not able to help and I was told a supervisor would call me back. That call never came.
It is a scam.
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