Congress set to ban surprise medical billing

[audreyh1]

I heard vague references to it a while back, but didn't realize I was already protected by a Texas law that went into effect on Jan 1 2020.
https://www.bcbstx.com/provider/news/2020_04_13.html

[ziggy29]

Quote:

Originally Posted by audreyh1 I heard vague references to it a while back, but didn't realize I was already protected by a Texas law that went into effect on Jan 1 2020. https://www.bcbstx.com/provider/news/2020_04_13.html

More states are doing this. This has been Oregon law since mid-2018. Colorado passed fairly extensive legislation that took effect on 1/1/2020. But those folks with national plans that cover beyond state lines can benefit too, since now they will be protected from surprise billing if they need care while outside their home state.

[jollystomper]

Quote:

Originally Posted by GTFan Yes, a lot of MegaCorps like the one I retired from do self-insurance, where the insurance company just handles the claims but the corp pays the bills. So they're not covered by state regulators (a nasty loophole IMO, all insurance should be regulated).

Yes, this bill is a good thing.

AN interesting thing we had noticed was, when our Megacorp switched insurance administrators a couple of years ago, was that we were assigned and "advocate" as well as a "hotline number". Among the things we could use it for were billing issues. We did use them for a billing issue, I do not believe directly related to this topic, but the gist of it was "we'll take it from here", and the result was a corrected bill from the provider. My guess is that this is one of the things Megacorp negotiated with the insurer for the insurer to gain their business. The law will be helpful to further back it up.

[audreyh1]

NPR article said that "In Texas, federally regulated plans account for roughly 40% of the state's health insurance market."
https://www.npr.org/sections/health-...-medical-bills

[Popeye]

Quote:

Originally Posted by ziggy29 This is very good news. Long term it might be the best thing to come out of this package. I don't know how a health care consumer could do anything but support this one. Sure, if you freely elect out of network service ahead of time, pay for it, but no one should go to a network facility, have the reasonable expectation of in-network coverage, only to be billed $10K because the anesthesiologist was out of network, unbeknownst to the patient. Sounds like providers and insurers are going to have to negotiate how this is paid, going to arbitration if necessary. But the key thing is that they can't go after the patient for it.

If insurers end up paying more, won’t they try to roll it into premiums in the long term? Ofc, it’s better if everyone pays a tiny bit more instead on a few getting clobbered.

[ziggy29]

Quote:

Originally Posted by Popeye If insurers end up paying more, won’t they try to roll it into premiums in the long term? Ofc, it’s better if everyone pays a tiny bit more instead on a few getting clobbered.

It's all a shell game, really. All costs get reimbursed one way or another; there is just a lot of cost shifting. Insurers and providers won't just "eat" the loss without making it up somewhere else. If I have to pay a few bucks more for premiums in order to protect myself from massive surprise bills, I'll take it.

[audreyh1]

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.

[REWahoo]

Quote:

Originally Posted by audreyh1 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?!?

Check this out: Texas has more than 200 freestanding ERs. Lawmakers just passed bills to combat patient confusion and price gouging.

Note: The gov signed it into law.

[USGrant1962]

Quote:

Originally Posted by ziggy29 It's all a shell game, really. All costs get reimbursed one way or another; there is just a lot of cost shifting. Insurers and providers won't just "eat" the loss without making it up somewhere else. If I have to pay a few bucks more for premiums in order to protect myself from massive surprise bills, I'll take it.

+1

[audreyh1]

Quote:

Originally Posted by REWahoo Check this out: Texas has more than 200 freestanding ERs. Lawmakers just passed bills to combat patient confusion and price gouging. Note: The gov signed it into law.

Thanks very much. I have wondered about this for a long time! So a 2009 law authorized these types of facilities.

[audreyh1]

Quote:

Originally Posted by ziggy29 It's all a shell game, really. All costs get reimbursed one way or another; there is just a lot of cost shifting. Insurers and providers won't just "eat" the loss without making it up somewhere else. If I have to pay a few bucks more for premiums in order to protect myself from massive surprise bills, I'll take it.

There is more to it than that. If private equity firms or middle men were getting into the game to take advantage of a loophole, that is additional cost to the consumer that didn’t exist before.

[ziggy29]

Quote:

Originally Posted by audreyh1 There is more to it than that. If private equity firms or middle men are getting into the game to take advantage of a loophole, that is additional cost to the consumer that didn’t exist before.

Well, sure. Insurance companies are that, too. Every extra layer of "middle" means another pound of flesh. But the takeaway is that every entity that intends to be made whole will be, one way or another.

[audreyh1]

Quote:

Originally Posted by ziggy29 Well, sure. Insurance companies are that, too. Every extra layer of "middle" means another pound of flesh. But the takeaway is that every entity that intends to be made whole will be, one way or another.

Insurance companies are regulated and currently limited in the pounds of flesh they can take. I’ve been getting rebates the last few years.

[REWahoo]

Quote:

Originally Posted by audreyh1 Thanks very much. I have wondered about this for a long time! So a 2009 law authorized these types of facilities.

Yes, and almost overnight some less-than-upstanding folks figured out how to make big bucks with what we now call "surprise billing" so the free-standing ER industry boomed. I think the recent state and now federal laws will see many if not most of them fade away here in TX. I've already seen one (in Helotes) fold their tent and disappear.

[audreyh1]

Well so I gathered, and always looked askance at them. I believe our neighbor was ultimately able to resolve her $1000 surprise bill for a simple treatment, but it took a while.

Before that there was a serious lack of any type of urgent care or clinic type of facility in my area. Fortunately now I know that if I have an immediate problem I can call my PCP’s office and at least a nurse practitioner will be able to see me probably that day. Including Saturdays.

[ziggy29]

Quote:

Originally Posted by audreyh1 Insurance companies are regulated and currently limited in the pounds of flesh they can take. I’ve been getting rebates the last few years.

Yes, but since that "limit" of flesh is greater than zero, my point stands.

[audreyh1]

Quote:

Originally Posted by ziggy29 Yes, but since that "limit" of flesh is greater than zero, my point stands.

Without single payer for under 65 we are stuck with insurance companies.

But at least we are getting rid of most of the surprise billing on top of that, which in many cases represented additional middle men.

[chassis]

The bill, and the need for it, is just one example of how broken the US healthcare system is.

No employee in healthcare has ever made a credible argument refuting this. In fact I have heard career healthcare professionals admit the system is broken.

Compare the US vs other developed countries on healthcare expenditure as a percentage of GDP. Then compare the same countries’ “outcomes” such as life expectancy at birth, prevalence of disease, infant mortality, etc. It’s embarrassing how much this country pays for healthcare and how little it receives in exchange.

It’s great to see this bill turned into law. The system needs a complete overhaul and “socialized” medicine, to use a 1970s fear mongering term, is the answer.

[6miths]

Quote:

Originally Posted by REWahoo Yes, and almost overnight some less-than-upstanding folks figured out how to make big bucks with what we now call "surprise billing" so the free-standing ER industry boomed. I think the recent state and now federal laws will see many if not most of them fade away here in TX. I've already seen one (in Helotes) fold their tent and disappear.

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!).

[Octogirl]

PBS tonight had an interview with someone who knew details of the bill.
It was reported that patients airlifted in an emergency could NOT be billed - BUT ground ambulance services are NOT covered - so patients may get a bill.

Health care in the US is broken and there is ALOT of admin $$ waste.

I serve on the Board for an FQHC providing primary care to a mostly Latino community. I hate the for profit urgent care centers etc.