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Old 12-22-2020, 08:33 PM   #41
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Originally Posted by teej1985 View Post
What's the difference between getting a surprise bill and just not knowing that the doctor or facility is out of your insurer's network?

What scenarios does this legislation protect?
This law, which doesn't go into effect for another year, is mostly directed at the ER doc practices owned by private equity firms who purposefully pulled the groups out of insurance networks so they could charge very high fees and not be subject to negotiated fees. Your free market healthcare at work!
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Old 12-22-2020, 09:25 PM   #42
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This would explain why it's not any better than it is.

https://www.politico.com/news/2020/1...ongress-449759
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Old 12-23-2020, 03:55 AM   #43
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Very good news. We've been hit with surprised bills twice, once when our daughter was born (anasthesiologst) and again when my wife got bit by a cat and went to the ER.

Now here is my dream second piece of legislation:

Massive penalties and fraud indictments for insurance companies that hide behind their own complexity to send customer erroneous bills and make the customer chase down the corrections.

I'd suggest the penalty is repayment of the charge plus a 100% penalty rebate.

And if the customer is elderly, is should be a 1000% penalty rebate -- 10x the value of the charge.

My wife spends a boatload of time running this stuff down, its ridiculous. And when folks get older, they often just don't have the attention or ability to chase this down. Has to be worth billions to the insurance companies.

Its criminal.
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Old 12-23-2020, 09:51 AM   #44
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Originally Posted by Closet_Gamer View Post
Very good news. We've been hit with surprised bills twice, once when our daughter was born (anasthesiologst) and again when my wife got bit by a cat and went to the ER.

Now here is my dream second piece of legislation:

Massive penalties and fraud indictments for insurance companies that hide behind their own complexity to send customer erroneous bills and make the customer chase down the corrections.

I'd suggest the penalty is repayment of the charge plus a 100% penalty rebate.

And if the customer is elderly, is should be a 1000% penalty rebate -- 10x the value of the charge.

My wife spends a boatload of time running this stuff down, its ridiculous. And when folks get older, they often just don't have the attention or ability to chase this down. Has to be worth billions to the insurance companies.

Its criminal.
I think I agree with what appears to be the sentiment of this post.

To me it's faster and easier to implement a system like Germany's or the UK's.

One recent example I experienced: my dentist over-recommended hygienic cleaning of 3-4 visits per year. What a crock. And the hygienist put her hand on the x-ray machine as I was sitting in the chair for a cleaning. I asked, what are you doing? She said it's time for x-rays. I said, "no it's not". She didn't say a thing. And she didn't ask me if I wanted x-rays before assuming she would take the pictures and charge me accordingly.

Too many examples to write here. The providers are bilking the insurance companies and the insurance companies have their hands in the pockets of whomever isn't guarding their pockets. Employer-sponsored health insurance is broken because corporations continue to step backward away from unwarranted and unmerited premia increases, leaving the employee (consumer) to eat the increase. The insurance companies don't skip a beat, and try to put their hands deeper into the consumers' pockets.

Providers, drug manufacturers and device manufacturers need to take pay haircuts and become efficient like the rest of the world.
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Old 12-23-2020, 09:58 AM   #45
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What I want to know is, what is the deal with all these "free-standing emergency medical care facilities" that have popped up here over the last 6 years or so?!? There used to be 0, none. Now there are 5 or 6 of them within the few interstate blocks between me and the grocery store.

I know that one resident complained and warned other residents a few years ago about a large balance bill after visiting one. And she was on Medicare! They "told" her they accepted Medicare. If it was only verbal, who knows.

Anyway - I always have wondered if they were operating under some loophole.
I've wondered about these, too. They wouldn't be popping up all over if there wasn't money in it. Maybe insurance companies are covering more treatment here to keep people out of ER's.
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Old 12-23-2020, 10:04 AM   #46
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Over on the doctor's forum I frequent there is a thread titled, 'The end of emergency medicine' in response to this bill. I am figuring that they are referring to this entrepreneurial brand of ER but the system is so weird that it is hard for an outsider to know. DW and I are always struck by the huge number of billboards we ads for different 'ER's in south Florida and the Tampa area when we visit. In these parts ER = Major Hospital and the surprise bill one gets is for a $50 air cast (although for some reason $0 if you get a real cast!).
Here is the eye-opening reply from REWahoo. Makes much more sense now! I figured that there was some kind of loophole being exploited based on the way overbuilding of these facilities in a short amount of time.
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Still No Prices
Old 12-23-2020, 10:34 AM   #47
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Still No Prices

From the 10:25PM link, above:
Quote:
The spending deal puts guardrails in place. Mediators can't weigh the sky-high charges providers bill when settling on the amount insurers will have to pay for their customers’ out-of-network care. But arbitrators also can't consider Medicare rates, which employer groups and others wanted to serve as the price peg in order to curb costs.
So I wonder what prices the mediators will use. The negotiated prices between providers and insurance companies are secret.
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Old 12-23-2020, 12:19 PM   #48
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Originally Posted by sengsational View Post
From the 10:25PM link, above:
So I wonder what prices the mediators will use. The negotiated prices between providers and insurance companies are secret.
I get a glimpse with every billing I receive from my health care provider. For example, chiropractor bill will show me how much he charged; $350 for the visit, how much the insurance company covered $50 and how much I owe $20 co-pay. The doc got a total $70 from a $350 billing I would have had to pay if not for insurance.

My father's ambulance ride shows the same thing; what they charge itemized out, what the insurance paid and any co-pay (there was none).

My recent surgery shows the same; billing amounts for pre-op, anesthesia, etc. How much the insurance paid and my co-pay. (there was no co-pay)
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Old 12-26-2020, 07:57 AM   #49
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This happened to us. Only bill ever received was the total before Medicare paid for $85,000.00. We were then told to wait until that was done then we'd receive the real bill. Then a delinquent notice from the US Treasury. Immediately after - garnishment of SS income. Huge chunks. They also tacked on $641.00 in 'admin fees' and penalties for a bill we never received from Brooks Army Medical Center two years ago. There's no disputing or negotiating. It's the government.
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Old 12-26-2020, 08:38 AM   #50
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Really? From BAMC? DO you have tricare prime? If so, thats outrageous
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Old 09-13-2021, 04:53 PM   #51
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I know this is an old thread. But I have a few surprise bills today so I am looking forward to have this law take effect on January 1 - 2022.

Here in CA this is already law, since 2019, but since my insurance is out of state that may not be helping me. I am waiting for official EOB to find out what the next step is.
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