Blindsided - Patients squeezed in feud between docs, insurance companies

Houston Chronicle ^ | 11/19/2017 | Jenny Deam

[Alberta's Child]

You will never have “free enterprise principles” in health care unless people pay their own bills directly. There are no such principles at work in a system built on third-party payments.

[babygene]

“There are signs everywhere in ERs saying advance directives will be disregarded in the ER too.”

When you sue them, who do you think the jury is going to side with?

[longtermmemmory]

it will never get there. summary judgment. the law requires the er stabilize. AFTER that patient can be moved or plug pulled if directed.

[vette6387]

“So, I would assume that among the high prices on the ER bill, his costs would have been included. They were not.”

What you find in most hospitals is that nearly every “service” they “provide” is “outsourced.” The ER physicians in our local hospital are “independent contractors,” so they bill you separately. Ditto for the Radiology Dept, which “rents” space in the hospital for their equipment, but are also independent contractors. Same for the anesthesiologists. Pretty soon, you will find a bill from “The Amalgamated Bed Pan Emptiers” for getting rid of your $hit, and a tab from the group that “rents you” your hospital bed together with a charge for every time the damned thing weighs you!

[Chode]

part of the problem lies in the fact that many hospitals use contract docs for the ER, if they worked directly for the hospital they'd be in network

[vette6387]

“You will never have “free enterprise principles” in health care unless people pay their own bills directly.”

Exactly! When insurance companies were finally successful in decoupling the patient from their bill, was when all of this crap about bill kiting started. But it’s that way with everything. Never let your property taxes or insurance be collected by your mortgage lender, because it’s a big, big income producer for them as they collect on a monthly basis, monies that are due once or twice a year.
But the biggest scam going is credit card interest. Just saw a monthly VISA bill of ours. It was $835.00, but the minimum payment required was $35. We use credit cards as a convenience and pay them in full when due. I can’t imagine the interest costs if you pay them off at the minimum required monthly payment. Actually, you never pay them off in that scenario. It used to be that you could get probably 25 days of “float” on a credit card, but not any longer. You get less than a week now to make payment before the interest charges are assessed.

[unixfox]

This is also true with me. The wife had an incident that landed her in the hospital for 9 days. After 3 days they transferred her to another hospital directly across the street. Of course the ambulance to take her across the street charged us $1500 for that little ride.

Bills started coming in from the out of network hospital AND from the in network hospital who had staff NOT in the network.

I threatened everybody involved with lawsuits and never settled one single bill I knew was bullshit. They all STFU and I haven't heard nary a peep from them. I told them to call Ovomit and he would take care of it!

[Hepsabeth]

One of the fun things about Obamacare.

This particular scam was going on long before Obamacare, along with plenty of others. Three would be no Obamacare if providers and insurance companies treated people fairly and honestly instead of ripping them off every chance they got.

[kingu]

See, if the counter person at the auto repair place sent you a bill for calling a mechanic in to work on your car, you’d blow more than a gasket. But if Congress said that such bills couldn’t be blown off in bankruptcy or even challenged in most courts, that could be a possibility.

It’s not a scam, it is an inevitable result of removing the ultimate balance point to ripping people off. Just like education has skyrocketed in cost - no one can walk away from the bill.

The ONLY thing going for the public is just how many of these bills are out there. To the point now where you can negotiate down a bill to $20-40, because that’s all the collection agency will pay for that paper. (Amounts above $5 grand still get a significant premium from collectors, so you’re on the hook for far more there.)

As most college paper is well beyond 5 grand, and collecting it is so easy, negotiating those bills down is virtually impossible. The same might be said for medical paper as language has repeatedly seeped into the ‘repeal’ legislation that would open access for medical bills to use the same programs.

But why are those bills so high to begin with? The ER referral bill you got was likely around $1400. Of that, the doctor likely got $80. His ‘practice’ (most usually a couple family members who occasionally handle paperwork) likely got $60. The remaining 90% goes to the agency that staffs the ER, the medical coding shared cost, the medical billing company, etc.

A segment might have gone to the hospital, that would be the portion that the insurance ‘paid’ (if any, depends on the hospital.)

[kingu]

“There are signs everywhere in ERs saying advance directives will be disregarded in the ER too.”

When you sue them, who do you think the jury is going to side with?

I'm sorry, part of the monstrosity of Obamacare was 'bankruptcy reform' that excluded court oversight of medical billing and college costs.

No court date for you.

[markman46]

welcome to the real world.. insurance contract with PCP, Specialist and Hospitals.. ancillary radiology, labs, anesthesia, etc might or might not be contracted with said insurance. this has been going on for at least 30 yrs.. I should know i have worked in health insurance claims for over 25 yrs.. most of the time you tell them they can’t balance bill and u will call the state or fed on them

[Daffynition]

Add to this morass, I have found my primary *sent* me to a specialist [in network]; turns out the specialist, [unknown to the primary doc] no longer takes medicare patients.

So down the line, docs are picking and chosing......only to add to the confusion.

Making a simple appointment can take weeks of challenging back-n-forth.

[gspurlock]

Correct. This mechanism was created by the Government. I forget if it was the 1st or 2nd World War, but the then president froze wages to prevent businesses from offering higher salaries to the experienced men still in the workforce due to the number of men who were in the military.

As a result, companies found a different way to attract the highest qualified personnel. They started offering benefits instead, including health insurance, longer vacations, etc. After the war when salaries were no longer frozen, that business practice remained in place.

Having so many businesses providing health insurance is what caused this system. People used to pay for their own care and doctors were still rich. Then to add insult to injury, because insurance companies were so rich, medical errors started lawyers on an assault to get their cut with outrageous payouts to patients injured, with the bulk of the settlements going to the lawyers, not the injured patients.

This created the need for medical mal-practice insurance which skyrocketed in short order due to the excessive settlements, further driving up the cost of medical care. The simple truth is that if health insurance was eliminated, most people would be able to pay for routine health care and only have a need for catastrophic coverage. That would be cheap enough for everyone to afford, and in the rare cases where it was actually needed, comprehensive care could be provided without endangering either the providers, the insurance companies or the patients.

These things can be reversed. In fact it is already starting. Since it is now standard practice for companies to provide health insurance, they are relying more and more on contract workers who do not receive those benefits.

Doctors and hospitals charge lower fees/rates to the uninsured because they don’t have to do all of that paperwork which also drives up costs because health insurers are very reluctant to actually cover the health care costs and fight many of them.

We need to get government out of health insurance and health care. Companies should not be compelled to provide health insurance. It’s a very destructive bloated system and free enterprise principles are the only way to correct it.

Try to remember, almost every corrupt practice can be traced to government interference trying to control people instead of serving them and their best interests.

[j.argese]

Under Duress

Here's my attorney's name.

En-JOY!

[rstrahan]

Florida in 2016 outlawed ‘balance billing’, only making patients liable for in-network co-pays. Stopped the practice cold.

When I had Aetna in Texas, I could appeal the denial and Aetna would step up and pay the difference. Now I know things have changed with Obamacare rules but Texas could take a big step.

[Tilted Irish Kilt]

tje :"This crap happens all the time..
If it’s not the doctor who’s not ‘in-network’, it’s the lab, or the anesthesiologist."

The only way around this insurance pyramid scheme is to get supplemental healthcare insurance
if you can afford it after your regular insurance costs.
To my mind, it is the only way that you can leave an inheritance to your beneficiary , or children.

[sparklite2]

That’s clever. What do you do? Demand another doctor?

[RightField]

Mr. RightField had scheduled knee replacement surgery in an "in-network" hospital with an "in-network" surgeon. However, the anesthesiologist used was out-of-network. The authorization papers we signed at the hospital at check-in did not include specific authorization for the anesthesiologist. We assumed that since the hospital and surgeon were in-network that all services provided would be in-network.

We were surprised to get a bill from the anesthesiology group for 40% co-pay since they were out of network. All the in-network services were included in the hospital stay charges.

Turns out the hospital, a 503(c) non-profit, has an exclusive contract with this particular group to provide anesthesiology services for all operations. We questioned our surgeon about this, saying that we should have been given notice that the anesthesiologist was not in-network.

The surgeon told us that he is required to use the anesthesiologists provided by the hospital if he wants to operate there. He cannot bring in his own.

In researching all this, I discovered that the hospital had recently paid an $11million fine for mislabeling out-patient surgeries as in-patient, thereby garnering more income for them. It was only after threatening the anesthesiology group and the hospital with a fraud complain that they backed down. We ended up not paying the anesthesiologist a cent.

This area is ripe for Qtam litigation, but most people just pay the bill and never pursue

[Alberta's Child]

Good post. The other thing that's happened is that more and more people are recognizing the whole medical insurance industry as a fraudulent scam and finding that's it's easier -- and cheaper -- to deal with doctors directly.

There was a classic case posted here a few months ago of a Freeper (or a relative of one) who was facing a non-emergency surgical procedure. I'll try to remember the details as best I can ...

Between the deductible and the copay, this person was going to be paying something like $23,000 out of pocket for the surgery. Before going ahead with it, he did a little homework and asked the hospital how much it would cost if he paid directly for the procedure instead of going through the insurance company. He ended up getting the surgery done for something like $7,000.

Just think about that idiocy for a moment.

I believe this person dropped his insurance immediately and stopped paying any premiums anymore. Between the annual deductible and the monthly premiums, he was better off putting the money aside and saving it for himself.

[gspurlock]

Thanks for sharing that story! It’s not surprising at all. Free enterprise principles are asserting themselves as we speak. But so many people have been so dependent for so long that it’s going to take a while for it to occur organically. It’s Adam Smith’s “invisible hand” at work tipping the scales. That said, we still need to do all we can to continue draining the swamp, or should I say swamps because we are surrounded by them and a prodigious amount of quicksand.

MAGA!!!