Congress set to ban surprise medical billing

[ziggy29]

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]

Free-standing emergency medical care facilities?

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

Emergency care

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.

 

[Buckeye]

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!

 

[GenXguy]

This would explain why it's not any better than it is.

https://www.politico.com/news/2020/12/21/surprise-billing-health-providers-congress-449759

 

[Closet_Gamer]

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.

 

[chassis]

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.

 

[Buckeye]

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.

 

[audreyh1]

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.

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.

 

[sengsational]

Still No Prices

From the 10:25PM link, above:

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.

 

[skipro33]

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)

 

[Rchaser]

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.

 

[MrsHaloFIRE]

Really? From BAMC? DO you have tricare prime? If so, thats outrageous