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posted by martyb on Monday October 08 2018, @09:18PM   Printer-friendly
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?


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  • (Score: 2, Informative) by Anonymous Coward on Monday October 08 2018, @09:28PM (8 children)

    by Anonymous Coward on Monday October 08 2018, @09:28PM (#746146)

    Are there still people out there who think politicians will fix this? The entire health care and insurance industries are some of the most regulated in the world. This will only add more crap that makes it more opaque and more expensive.

    It is at the point where if you have a $1k deductible and the actual price is $300 they will bill you $10k (ie, the "chargemaster"), so that you pay 3x more just for having insurance. But if you lie and say you do not have health insurance you can pay the correct rate of $300. However, if you mention at all that you do have insurance it is too late and they need to bill you the "chargemaster" rates.

    http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-by-pretending-to-be-uninsured/ [selfpaypatient.com]

    There is just no way this could happen without government meddling.

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  • (Score: 5, Insightful) by crafoo on Monday October 08 2018, @10:23PM (6 children)

    by crafoo (6639) on Monday October 08 2018, @10:23PM (#746176)

    More than heavily-regulated, these industries are poorly-regulated. I think it's fine to heavily regulate an industry as long as it is warranted and the regulations are in the best interest of the population.

    Instead, I think these two industries regulations are riddled with weird loop-holes, money-making schemes, tit-for-tat trade deals, and failed pet projects. Not only are they over-regulated, they are poorly regulated. Massive extra costs with no benefit to the industries or the population in general.

    The only solution I can see is to a concentrated, multi-year effort to slowly tear down most of the regulations, simplifying where they cant be removed. It would take representatives in the house and senate with the country's best interest in heart and mind.

    • (Score: 0) by Anonymous Coward on Monday October 08 2018, @11:15PM (4 children)

      by Anonymous Coward on Monday October 08 2018, @11:15PM (#746197)

      What is an example of something that is heavily, but not poorly regulated, in the US?

      • (Score: 1, Informative) by Anonymous Coward on Tuesday October 09 2018, @03:40AM (1 child)

        by Anonymous Coward on Tuesday October 09 2018, @03:40AM (#746273)

        Electrical standards? Fire protection standards?

        • (Score: 0) by Anonymous Coward on Tuesday October 09 2018, @04:20AM

          by Anonymous Coward on Tuesday October 09 2018, @04:20AM (#746276)

          I hear commercials on the radio every day about how fire standards are subpar where I live.

      • (Score: 3, Insightful) by c0lo on Tuesday October 09 2018, @08:50AM (1 child)

        by c0lo (156) Subscriber Badge on Tuesday October 09 2018, @08:50AM (#746339) Journal

        Aviation safety.

        --
        https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
        • (Score: 2) by crafoo on Wednesday October 10 2018, @12:51AM

          by crafoo (6639) on Wednesday October 10 2018, @12:51AM (#746739)

          Good example I think.
          I think meet packing has come a long way since the early 1900s too but still some pretty awful aspects to it.
          Forestry, also. Not sure if I'd call it heavily regulated though.

    • (Score: 0) by Anonymous Coward on Tuesday October 09 2018, @02:36AM

      by Anonymous Coward on Tuesday October 09 2018, @02:36AM (#746262)

      It will take representatives in the house and senate with the country's best interest in heart and mind.

      Gotta vote for 'em

  • (Score: 0) by Anonymous Coward on Tuesday October 09 2018, @09:05PM

    by Anonymous Coward on Tuesday October 09 2018, @09:05PM (#746618)

    You can pay that correct rate if the physician has a cash-discount rate. In theory that cash discount rate still cannot be lower than the highest amount that any insurance contract will reimburse. If the insurance company finds out that a provider is in fact regularly taking less money from a cash-paying patient than they are contracted for the insurance company will come back full force on that physician that the physician will owe the insurance company back the difference between the cash schedule and the rate the insurance paid out. The insurance company is *supposed* to pay less to the physician than a cash paying patient. Physician takes less money but gets more volume from being in-network.

    Same is true for physicians who write off patient co-pays/deductibles/coinsurance amounts but for a different reason.

    Will the physician be caught? Maybe not. But smart physicians know to charge their cash-paying patients at least $1 more than the highest rate paid to them by any insurer they want to keep.