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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: 0) by Anonymous Coward on Monday October 08 2018, @10:34PM (1 child)
So now the insurance companies' conspiracy will dictate the maximum amount a hospital can receive for ER care. That'll work. Yep. It won't give "the ER physician" jack shit in terms of negotiating anything. But since the tail was already wagging the dog so hard it can't walk might as well allow it to start making the dog do 360s.
Here's a different idea: Make the insurance companies pay 100% of the fee the ER wants to charge if there is no contract in place - the insurance company took the patient and they can be liable for the patient's risk. Then let the insurance company set the rates it will charge their customers. *That* will give the hospital some negotiating leverage to make sure the insurance plan actually plays fair the with providers.
Oh, and did the bipartisans also insure that the *transfer* will be covered 100% by the insurance plan which is demanding that the patient be moved to an in- network facility? Did you make sure the ambulance transporting you was in network? Oh, sorry, you died because you were stable and then went back to unstable waiting for the in-network ambulance to arrive.
The insurance plans can stop dictating how physicians will practice medicine any day now. I currently have what may become a surprise bill. The reason was that the hospital is in fact in network with my insurance, but wants to make the ER physician consult with the insurance company before the patient (me) would be admitted. Because they didn't do that the insurance company is refusing to pay the hospital for the services rendered. THAT is restriction of practice. And they do shit like that ALL the time.
The insurance companies should be making their money by sharing out the risks among a patient population. Instead they make their money by barricading and stopping physicians from choosing to practice in a way they feel is medically best for their patients.
Now can we talk about how this nifty little idea will stop anyone from insurance from hitting the ER anytime they feel like it? "Can't bill me, Mr. Doctor. I got insurance so you just talk to them OK!" Then again, might be nice to see the insurance company proper go after the patient for the portion that the patient owes. Yeah, let's change the whole insurance system over to that. Then we'll talk.
(Score: 2) by sjames on Monday October 08 2018, @11:56PM
You seemed pretty crazy from the first paragraph, but the last one clinched it. Nobody in their right mind goes and sits in an uncomfortable waiting room for 8 hours just because they feel like it.