It’s a jungle out there when you are in pain or have a health problem. It’s no secret that we are all paying more for medical care and that the segmentation of care by the hospitals and the practices they purchased is a huge cost driver.
There was a time before high deductibles when we all had reasonable copayments for the care we received. Most of us also had out-of-network benefits as well and could go to any provider we wanted while having insurance coverage.
As insurers manipulated the market further with the onset of Obamacare in 2010, by 2015 we saw massive consolidation of doctors’ practices which were purchased by large hospital systems or by wall street firms looking to make a buck. Large hospital systems became larger as tiered networks were allowed, forcing lower-tiered hospitals to join the largest systems to stay in business. A local example of this was St. Peters Hospital which joined the already large RWJBarnabas system. Hospitals have reduced negotiating power of insurance companies resulting in higher healthcare costs for all of us, justifying the ever-increasing yearly premiums for health insurance regardless of being self-insured or fully insured. We all use the same networks and pay their negotiated fees regardless of how we are insured. Also, obscene pricing out of the network has been hidden for years by the way physicians and hospitals break down their billing to justify their fees.
Hospitals to save money began to outsource ER staffing and other services and many of these providers were not in your network even though they were in your in-network hospital. Other services such as anesthesia groups were purchased by wall street firms (with my friend’s group being a prime example).
This resulted in outrageous bills for services that were out of network and ironically, not covered by your insurer since they eliminated most if not all out-of-network coverage leaving you with a surprise bill that made no sense for the amount of service you had provided.
Legislators have taken forever to finally address this problem resulting in a new federal law calling for transparency for most healthcare providers. Our office has always practiced price transparency and has always charged reasonable fees for the services we provide. This is in contrast to the hospitals and the affiliated physicians who relentlessly bill people ala carte.
The new law affects primarily people who are uninsured or those who were billed by providers who were working within in-network facilities but sending patients out-of-network bills that would not be covered as they no longer had any out-of-network coverage.
Will these changes help consumers of healthcare services? Maybe we really need to enable people to purchase a public option that would force insurers to faithfully negotiate and assert leverage on hospital systems to reduce our costs. Check out this article from the NY Times below.
A New Ban on Surprise Medical Bills Starts Today
If you have a medical emergency, you will no longer need to worry about a large bill from a doctor you did not choose.
By Margot Sanger-Katz Published Dec. 30, 2021
For years, millions of Americans with medical emergencies could receive another nasty surprise: a bill from a doctor they did not choose and who did not accept their insurance. A law that goes into effect Saturday will make many such bills illegal.
The change is the result of bipartisan legislation passed during the Trump administration and fine-tuned by the Biden administration. It is a major new consumer protection, covering nearly all emergency medical services, and most routine care.
“I think this is so pro-consumer, it’s so pro-patient — and its effect will eventually be felt by literally everybody who interacts with a health care system,” said Senator Bill Cassidy, a Republican from Louisiana, who was part of a bipartisan group of lawmakers who wrote the bill. He said he counted the bill as among his top achievements as a lawmaker.