Wait...what? Out of network problems are gone now?

[RetMD21]

The out of network issue at an in network facility has always been a problem. If my in network surgeon is operating on me at an in network hospital, how am I supposed to know the the contracted anesthesia group at that hospital is out of network? Or that the contracted radiologist who read my CT scan done at that in network hospital is out of network? It's not like I get to pick and choose those things.

Hospitals can require contracted specialists to participate in the networks but it hasn't necessarily been in their interests to do so.

 

[travelover]

The petty crooks wear hoodies, the big crooks wear suits.

Hospitals can require contracted specialists to participate in the networks but it hasn't necessarily been in their interests to do so.

 

[ERhoosier]

AMA is standing with the doctors and services that have surprise billing as a business model. Unfortunate but not unexpected.

You misplace the blame which really belongs more on health care systems.

The vast majority (~70%) of US doctors are now employees, not private practitioners with control over their businesses.

https://www.modernhealthcare.com/pr...ployed-hospitals-or-corporations-report-finds

And, FWIW- The AMA has dwindled down over the years to now representing under 20% of practicing US doctors (by membership). It has actually become somewhat of a fringe group these days.

https://www.medpagetoday.com/opinion/campbells-scoop/80583

 

[RetMD21]

You misplace the blame which really belongs more on health care systems.

The vast majority (~70%) of US doctors are now employees, not private practitioners with control over their businesses.

https://www.modernhealthcare.com/pr...ployed-hospitals-or-corporations-report-finds

And, FWIW- The AMA has dwindled down over the years to now representing under 20% of practicing US doctors (by membership). It has actually become somewhat of a fringe group these days.

https://www.medpagetoday.com/opinion/campbells-scoop/80583

Yeah, as I said a fringe group that represents the grifters

 

[RetMD21]

Here's the CMS template for waiving your surprise billing rights. It looks like it would be hard to miss https://www.cms.gov/files/document/...s-emergency-facilities-regarding-consumer.pdf

 

[FLSUnFIRE]

Not a lawyer but the thing I don't get is in general contracts needs certain elements to be enforceable. Meeting of the minds... having a layman sign sheet after sheet of documents that are in legalese most of which they do not understand hardly satisfies a meeting of the minds to me. Which brings me to another thing, the patient/guardian, is getting these forms while under duress of a real/perceived medical emergency and in general, contracts entered into under duress may not be enforceable especially when with huge differential in the power and sophistication of the parties. I just find it unseemly at best and near criminal at worst.


I do my DD when I can but in an emergency that can be near impossible. So far, I've been pretty happy with my insurance and providers but have only dealt with "emergency" situations with my ex-wife and probably got a little lucky.



Not a king either, but if I was king for a day, I'd have menu pricing with standardized definitions/terminology, all parties pay the same, no negotiated prices (for gov't, insurance co, anyone, no exceptions with big penalties). Patients are to told up front the total to be billed and can better choose facilities that are cost effective. Insurance would clearly state how much they'll pay (either in $ or percent) for each service/drug regardless of provider using the same terminology. This would generate some cost competitiveness and eliminate some of the leaches/middlemen.