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from the meanwhile-don't-get-sick-or-hurt dept.
The bipartisan plan to end surprise ER bills, explained:
The policy proposal, which you can read here, essentially bars out-of-network doctors from billing patients directly for their care. Instead, they would have to seek payment from the insurance plan. This would mean that in the cases above, the out-of-network doctors couldn't send those big bills to the patients, who'd be all set after paying their emergency room copays.
The doctors would instead have to work with patients' insurance, which would pay the greater of the following two amounts:
- The median in-network rate negotiated by health plans
- 125 percent of the average amount paid to similar providers in the same geographic area
The Senate proposal would also require out-of-network doctors and hospitals to tell patients that they are out of network once their condition has stabilized, and give them the opportunity to transfer to an in-network facility.
[...] it's pretty good policy too! That's the general feedback I got from Zack Cooper, an associate professor at Yale University, who, along with his colleague Fiona Scott Morton, has done a lot of pioneering research to uncover how frequently and where these surprise bills happen.
"It is fantastic that they're doing something, and that it's bipartisan," he says. "It's one of those areas where we can agree what is happening now is not good, and this gets us 80 percent of the way to fixing it."
[...] "My concern here is that in-network rates are already quite high, so we're cementing that into the system," he says. "The current world gives emergency physicians tremendous power in negotiating higher in-network rates."
See also: Emergency room visit costs: what's the price of care?
(Score: 5, Interesting) by PartTimeZombie on Monday October 08 2018, @09:30PM (35 children)
This seems like a stupid plan.
So someone is going to pay either:
The median in-network rate negotiated by health plans
125 percent of the average amount paid to similar providers in the same geographic area
Am I the only one who can see several ways unscrupulous people are going to profit even more from that?
What is the chance of the US getting a proper taxpayer funded healthcare system, like the rest of the civilised world enjoys?
(Score: -1, Flamebait) by Anonymous Coward on Monday October 08 2018, @10:05PM (14 children)
You like socialism. There are many countries where you can enjoy this. You are not prohibited from leaving the USA to seek the worker's paradise of your dreams.
I don't like socialism, anarchy, Islamic theocracy, or communism. There is only one country for me. I'm stuck here fighting to preserve what I like. Leave me alone. Quit trying to take my choice away.
(Score: 5, Insightful) by Immerman on Monday October 08 2018, @10:07PM (3 children)
Why do you claim they have less right to to choose the direction of their supposedly democratic homeland than you do?
(Score: 0) by Anonymous Coward on Monday October 08 2018, @10:54PM (1 child)
Where does this idea that the US is supposed to be a democracy come from? Just because people vote doesnt make it a democracy.
In the US the constitution is supposed to trump the will of the people (but there are mechanisms to amend the constitution if enough people want it to happen):
https://en.wikipedia.org/wiki/United_States [wikipedia.org]
(Score: 0) by Anonymous Coward on Monday October 08 2018, @11:59PM
Welcome to the 21st century, Rip van Winkle! I am very sorry to inform you, but for quite a while now, SCOTUS has used the following process:
1. Would the Ninth or Tenth Amendment prohibit the law? If yes, proceed to the next step. If no, proceed to the next step.
2. Does the law involve commerce of some kind (interstate, intrastate) or can it potentially involve commerce or is it regard something that somebody could conceivably put up for auction or sell to a neighbor? If yes, the interstate commerce clause allows the law to stand. If no, proceed to the next step.
3. Is it a state law that upon first glance would be outside of the jurisdiction of the federal government? If yes, the equal protection clause of the Fourteenth Amendment prohibits the law. If no, proceed to the next step.
4. If yes was obtained for the first step, the due process clause of the Fourteenth Amendment prohibits the law.*
5. Otherwise, the necessary and proper clause allows it.
Any questions?
* Note: Step 4 may be changing soon! Huzzah for ASS-JUSTICE Kavanaugh!
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @05:57AM
I can't go anywhere else in the world to get my freedom. The USA is all there is. If the USA falls, then I don't have freedom.
If you hate freedom, you have so many choices! Take the UK for example. You get the NHS, you're totally safe in London because it is prohibited to carry knives, cameras are everywhere so you're doubleplus safe, and you can get your conservative opponents sent to die in jail if they suggest that Islam kind of sucks. It's like that all over the world, or sometimes with even less of that annoying freedom! Go. Be happy.
(Score: 4, Insightful) by PartTimeZombie on Monday October 08 2018, @10:19PM (2 children)
You have drunk the kool-aid.
Keep pretending the awful health system you're stuck with is the "best", or that you have a "choice" nobody is buying it though. [internationalinsurance.com]
FYI, I don't live in the US, and never have. I have visited however. Can I extend an invitation for you to visit my country? You never know, it might open your eyes.
(Score: 4, Touché) by c0lo on Monday October 08 2018, @10:24PM (1 child)
But then... how can he have the perpetual American dream with the eyes opened?
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 3, Insightful) by Anonymous Coward on Tuesday October 09 2018, @12:43PM
“It's called the American dream because you have to be asleep to believe it”.
(Score: 0) by Anonymous Coward on Monday October 08 2018, @10:41PM (2 children)
we have socialized medicament TODAY. You nit.
VA is socialized medicine
Military is socialized medicine.
Medicare us socialized medicine
...
There quacks in there just is in real life. So do not bang your frying pans to make noise.
With single payer for example means "single" rate everywhere. There maybe to add-ons for NY for cost of housing. Or rural area getting a bonus - like paying off your student loans. outside of base rates. But that would to help defuse the medical to ALL, versus just Mayo or Chicago.
Look to Kaiser Healthcare, setup in WWI to help keep ship builders to build ships in Richmond Calif. It is defined and codified in US LAW even. It has great power in keeping costs low, since it is getting paid a flat amount take covers all functions the population that has signed up need. Even including $15,000 boot for 6'10" with an amputation. No rate increase it is part of the plan.
Hell look at your auto insurance... you are at fault for $500,000 in a accident. YOu have nevered paid $500,000 in the system... but you will take that out. Staying with company will have minor up tick in how much you are paying... but to recovery $500,000. Health ins should be not different. Equal spread of the cost over ALL. For ALL to work - ALL must in in the plan. So as in Auto/home/Life insurance comapny spread the risk to other insurance companies to handle spikes. Healthcare can be thought of same.
Now get of my lawn and play in traffic!
(Score: 2, Touché) by Anonymous Coward on Tuesday October 09 2018, @12:01AM
Good thing single payer fell out of favor. It's all about Medicare for all these days.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @10:07AM
20-30 years ago, I would have agreed with you. The rates for kaiser have steadily increased while the quality of care of kaiser has steadily decreased for the past 2.5-3 decades.
And I say this as someone who had excellent pediatric care from them for most of my first decade of life, including a lifesaving operation by a specialist who even a big name research hospital was impressed by the surgical precision of.
Today, Kaiser is a pale imitation of what it once was.
(Score: 4, Interesting) by Runaway1956 on Tuesday October 09 2018, @01:52AM (3 children)
That sounds nice. But - what are your choices?
A: go to the doctors and use the facilities that your insurance company permits you to use
B: pay higher copay and/or pay out of pocket for costs that you won't be reimbursed for
I've had a number of insurance plans over the past 30 years plus. Recently, the company dropped blue cross / blue shield, and moved to United, which all the rest of the parent company uses. EVERYTHING is different, starting with the doctor I've been seeing since I moved to Arkansas. He won't take United - says it takes much longer for him to get paid, if he gets paid. Out of system? WTF? Where is MY choice?
(Score: 2) by PartTimeZombie on Tuesday October 09 2018, @02:08AM (1 child)
Wow, that's appalling. Your insurance company gets to decide which doctor you see.
(Score: 3, Informative) by Runaway1956 on Tuesday October 09 2018, @02:33AM
Indirectly, of course. They don't just come out and tell me that I can't see Dr. Nguyen - instead they make life difficult for the doctor, and cheat him out of money. The doctor can't stay in business if he doesn't get paid. Nor can he spend all his time playing the telephone game, trying to get paid. Nor can he pay a full time employee to play the game for him.
TBH - Dr. Nguyen will probably be shuttering his doors soon. The old guy doesn't arrive at the office until 10:00 or later most of the time. He just doesn't come in some days. I've forgotten just how old he is, but he was a practicing doctor in Vietnam before the fall of Saigon. The wife and I have talked about finding a new doctor, but haven't done so.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @06:03AM
Before shit hits the fan, I could decide to buy a different insurance.
I can get a cheap crappy one, saving the money. It's a gamble I ought to be allowed to take. Who are you to stop me? I can even take that to the extreme, getting no insurance at all.
I can get a fancy one, with special on-call services. If I want to blow my money on that, who are you to stop me?
As for "the company dropped", yeah, that's fucked up. Your employer is involved in your health insurance because of wage controls that were imposed many decades ago. Adding employee benefits was a work-around, competition made it universal, and Obamacare wrote it into our law. That is really shit. Your employer should have nothing to do with your health insurance.
(Score: 2) by Immerman on Monday October 08 2018, @10:35PM (15 children)
I don't see how it would be any worse.
Currently you get billed one of:
The in-network rate, to be paid by your insurer, if your insurer's network includes the provider
A completely outrageous rate, quite likely many times that amount, to be paid by you, if you don't have insurance, or aren't in-network
Under the new plan it sounds like that second number would be limited to 1.25x of the median amount billed to regional in-network insurers in the area. And it would be billed to your insurance.
Now, they don't say (in the summary at least) whether your insurer can pass that bill on to you, but even if they do, it's almost certainly substantially less than you would be billed otherwise.
Basically, these days doctor bills fall into one of two categories -
in-network, in which case your insurer pay the standard rates they've negotiated,
or
whatever number they make up, because there's absolutely no oversight, and nobody will even hint at the prices upfront so you can't possibly comparison shop
And that's not just for emergency care - even something like giving birth with no complications, where you have months to consider your options beforehand - no hospital will even give you a hint at what the uninsured price will be, and that price can easily vary by a factor of 10 or more between comparable hospitals in the same city. (and of course even the insured rate is several times the billed cost in any country with socialized medicine, but that's a whole separate conversation.)
(Score: 0) by Anonymous Coward on Monday October 08 2018, @10:59PM (14 children)
This is a myth. Try shopping around for some healthcare and saying you dont have insurance. It is almost guaranteed to be at least half the price quoted to someone with insurance and quite often is even less than the deductible they would otherwise pay. There are links elsewhere in this thread that go into detail about it.
(Score: 2) by Immerman on Monday October 08 2018, @11:26PM (6 children)
That has never been my experience. And shopping around isn't an option if they won't tell you the price beforehand.
(Score: 1, Interesting) by Anonymous Coward on Monday October 08 2018, @11:43PM
Well it has been mine. I actually discovered it on accident then found out people already knew about this "trick". If you have a choice, always say you don't have health insurance first.
(Score: 2) by PartTimeZombie on Tuesday October 09 2018, @12:00AM (2 children)
If it's emergency healthcare how is anyone even talking about shopping around? How would you even do that?
Last year when Mrs. PartTimeZombie fell down the stairs and broke her ankle, do you think I phoned several hospitals for a quote?
What I did was phone an ambulance which took her to the hospital where she was treated. At no point did I worry about the stupid concept of "in network" or "co-pay".
After several months of care, including two operations I had paid about $100 for some extra physiotherapy and whatever parking at the hospital cost because I had already paid for everything else when I paid my taxes.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @12:10AM
You would first do it to go in for a non-emergency. Eg, the optometrist, dentist, dermatologist, or whatever. Then realize that you should be figuring out what you want to happen in an emergency beforehand. Here is an example:
http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-by-pretending-to-be-uninsured/ [selfpaypatient.com]
And if you still want that feeling of insured safety, just get a really cheap, high deductible plan for true emergencies and/or a health savings account.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @09:21PM
The way you could do that is to compare prices in aggregate before the emergency, and then use the ER that worked best for you in terms of price/location.
However, since no one will give prices, you are left with picking the closest one because they like to not give you actual choices.
(Score: 2) by dry on Tuesday October 09 2018, @04:52AM
Do they not post prices? I'm in BC (every Province is slightly different). Took someone to emergency recently, big sign with prices, both for Canadian residents (just over $500 IIRC) and higher for foreigners ($700 or $800 IIRC). Same at the Drs office, a price list of stuff that isn't covered, eg $100 or so for a work related physical (professional driver, airline pilot etc), x amount for a sick note etc. I didn't pay much attention to the actual prices.
Regular stuff is supposed to be billed at the same rate as the government pays as well, unless it has changed. Canadians often aren't aware that their medical doesn't cover them if they're not in their Province of residence and at least in BC, you have to register and if not poor, pay (about $70 a month for a single person, might be payed by your employer).
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @07:52PM
That's because your physicians are still honest, mostly.
Find me anyone, anywhere who will rightfully and honestly tell you what the bill to fix your car will be beforehand. Or your washing machine.
The best you will hope for is someone to tell you, "Well, if it is *X*, and *X* only, and there are no other complications that take more time, it will cost $Y." More likely you will hear, "It depends on what is wrong." Straightforward things like getting your oil changed, where they know there is no way it will take more time or knowledge or skill, those can be quoted. But medicine? Yeah.
What you'll hear from an honest practitioner is, "I won't know what it will cost until after we've had our meeting because I don't know how my of my time your health will take for me to work through your issues and I don't fully know what if any therapy or diagnostics you will need in my office at the time of your visit."
Anyone who tells you upfront, "Yeah, we'll see you for $Y" is likely overcharging on average - covering the more complex cases up with charging less complex more. Anyone who shops around for their healthcare on discount is likely to get discount healthcare.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @12:08AM (6 children)
Paying cash for my bloodwork labs cost like $700. Cost to insurace? $40 billed to insurance. A whole fucking order of magnitude less.
Office visits same thing but less dramatic. Without insurace? $125. With insurance? $50 billed to insurance, plus my co-pay.
Is there a specific procedure or state or geographical area where this is true?
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @12:12AM (5 children)
Does the place know you have health insurance?
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @01:57AM (4 children)
Was not insured at the time.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @02:04AM (3 children)
Whoops! That's wasn't the preview button!
I meant that I am comparing the cost from when I did not have insurance vs. my current situation with insurance.
Though it occurs to me... you're not taking advantage of sliding scale programs and other charities meant for low income people without insurance?... naah, an upstanding, wealthy capitalist like you would never do such a thing.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @04:27AM (2 children)
No, I meant simply saying you don't have insurance.
It sounds like maybe whoever you went to had some really crappy contract with the insurance company that required them to charge you x times more. Or maybe, was it before and after obamacare?
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @09:29AM (1 child)
Scenario 1: Before Obamacare. Without insurance. $700 for bloodwork. What magic words was I supposed to say?
Scenario 2: After Obamacare. With insurance. $40.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @10:11AM
No idea, some places might have contracts with insurers so they need to charge you more though. Dont go to those places.
(Score: 2) by driverless on Tuesday October 09 2018, @01:41AM (3 children)
Can someone translate this from US-healthcare-ese into plain English? I have no idea what this is proposing, or what the implications are.
(Score: 0) by Anonymous Coward on Tuesday October 09 2018, @02:04AM
I think what this is saying is instead of the vendor billing the patient then expecting the patient with no medical training to argue with their insurer about the medical necessity of everything to recoup what the patient pays to the vendor (or the collection agency the vendor turns the bill over too because it's so damn steep), the patient pays their ER visit copay upon presenting at the ER. The doctor then has to bill the insurer directly and the insurance people can argue with the physician about what was medically necessary or not.
But take that with a grain of salt. My only experience with this is I'm part of a team that writes software for health plans. I make no claims {pun intended} to actually understanding the logic of this system. Near as I can tell, it doesn't have any logic, but the people with the most political power end up with the most money when the music stops, so it must be working right. Right?
(Score: 2) by PartTimeZombie on Tuesday October 09 2018, @02:04AM
I think it roughly translates as:
"You or your loved one as been injured or is sick, so we're going to take all your money when we treat you.
Then, we are going to force you to incur a huge debt as well, because we can".
(Score: 2) by All Your Lawn Are Belong To Us on Tuesday October 09 2018, @05:07PM
What can happen (the "suprise billing" they mention) is thus:
1) Patient goes into Emergency Room and gets treatment.
2) The hospital has no contract with that particular insurance company.
3A) Insurance company has some requirement for payment of the patient's care the hospital did not comply with. They deny the billing.
OR
3B) Insurance company pays out-of-network benefits (which are less than the in-network benefits).
4) Hospital takes the cash from the out-of-network company, then bills the patient for the full remaining due balance. Hospital is not obligated to respect any limits to the bill the insurance company requests because there is no contract. (They often do, though.)
5) If that is 3A above, this is the full amount of the ER visit. This can be $1,000 and up, typically around $3,000 but $5,000 isn't unheard of. The patient has no protection from this.
If it is 3B the patient may be on the hook for around $1,500-$2,000 and up. (This is highly variable depending on what is wrong).
The way it works if one the hospital is in network is thus:
1) Patient goes into Emergency Room and gets treatment.
2) The hospital has a contract with the insurer limiting the maximum amounts of the charges possible.
3) Insurance pays the bulk of the bill, requires the hospital to write off a percentage of the bill due to the contract, and allows the patient to be billed around 10% to 20% of the remainder (plus any deductible not yet met).
OR
3B) Insurance finds a BS reason to deny payment of the bill. But the contract does say that the patient cannot be billed for any denials of payment.
4) Hospital takes the insurance money and bills patient the balance that the insurance allows (an "allowable" amount).
5) The patient pays the billed amount, typically from $300-$700. If the hospital screwed up the billing patient owes nothing.
The big difference between the two is that when a contract exists between insurer and hospital there is usually a clause which expressly limits what the hospital can be paid and limits what the patient can go after. The hospital, as a whole, signs the contract because they will receive more patient visits by being in network than not.
In theory if there is no contract then the hospital or doctor may directly bill the patient - there is no obligation to bill the insurance company. In practice this NEVER happens - it's more money to take out of network benefits than bill the patient. Instead they get the insurance money and then bill the full balance to the patient ("balance billing").
What this whole thing says is that it doesn't matter if the hospital or doctor has a contract with the insurer or not. The doctor or hospital is now compelled to bill the insurance and accept what the insurance gives them. Effectively forcing them to act as if a contract is in place but take less money overall for being out of network, without any benefits of being "in network" of better reimbursement rates or expecting greater volume to make up for the lack between what they hospital wants to charge and what the insurance will pay. It forces a contractual relationship where none existed before and none exists after.
This already happens with Medicare, by the way. See a Medicare patient and Medicare Shalt Be Billed, whether the physician wants to or not.
And yes, patients may choose which ER to go to and it does happen. People who have insurance and are smart will know which hospitals are in network and can request an ambulance to take them to that hospital in most jurisdictions. True emergency aside where the crew feels they must have a different hospital because of trauma level or distance aside, most of the time the patient's desire controls.
Last thing I'll note: Absent a contract (and except for Medicare) no hospital or doctor is obligated to bill insurance. It's always done, strictly as a courtesy to the patient and for the convenience of the hospital and physician. If I were to wave my magic wand, this would stop. The patient would be provided with the full bill of services and the patient can file that bill with the insurance company, receive the money and pay the physician's office that money. End the convenience of the triangular billing relationship and let the patient figure out how their insurance and being in network works (or doesn't). Or allow such billings only where contracts do in fact exist for the provider to bill the insurance. (No, this doesn't work for a few reasons. But I think it's a better solution than enforcing contracts that don't exist).
Hope that fills in some blanks.
This sig for rent.