The worst part is that Balanced billing and being out of network favors insurers. As seen in
linked NY Times article--they cost shift bill completely to patient, who gets Balanced Bill. It's a total scam by insurances which increases profit margin and passes costs to the patients. They basically low ball you when you are trying to get resonable and customary reimbursement, force you to be out of their riduculous network schedule fees (by charging 25% under usual and customary), then (somehow) we are the bad guys.
Here's
FCEP's retort to a similarly biased, non-sense article in the Tampa Bay times. United, who was in the initial TBT article was sued by NY for fraudently making up data to low-ball physicians (they settled, part of settlement was admitting no wrong-doing). They were forced to pay 90 million to set up the NY FAIR database, which would get average Usual and Customary reimbursements, which in theory would solve everything. Not surprisingly, once the database was up and running, THEY COMPLETELY IGNORED IT and came up with their own formula which pays 125% medicare (most negotiated OON fees get 250%-600% medicare rates--that's how we get paid when 40-50% of our patients don't pay). there was a loophole in the settlement which let them do this random formula.
If you are a Community Physician, this should drive you nuts and tick you off. The NYT, TBT, all the media are getting on the blame the doctor bandwagon for high fees and costs, even though ED's are responsible for <2-4% of all health care costs. Nevermind and hospitals are consolidating and making more money than ever--they're obviously lobbying better than we are. If you ask me, we are the low lying fruit for the govt to pick on, and they won't rest until all the private groups go out of business and we all become Hospital employees.
