Lawsuit To Ban Balance Billing

[medpsych1]

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http://www.stltoday.com/business/local/article_c61b9aef-8331-55fd-bf62-735724c4d547.html

If this lawsuit goes for the plaintiffs I think that physicians will be on the road to becoming serfs.

 

[JaggerPlate]

http://www.stltoday.com/business/local/article_c61b9aef-8331-55fd-bf62-735724c4d547.html

If this lawsuit goes for the plaintiffs I think that physicians will be on the road to becoming serfs.

"Health care providers should have a flat, set fee for their services, rather than charging different amounts depending on who is responsible for payment,"

Wow. Is there a reason why the public perception is that physicians/health care is just some evil, money grubbing ponzi scheme and that the utmost cutting-edge, state of the art technology and honed skill set of highly trained practitioners is a guaranteed right that should be provided at no cost to the consumer?

Absolutely absurd. By this logic, I should be able to walk into a luxury car dealership and demand that they sell me a Ferrari for the price that my neighbor paid for his Honda.

While I don't think the lawsuit will go anywhere, just a disheartening reminder of the current state of things and how you're/we're viewed by the general public - tools for their wellness that should come at no personal cost, work, or inconvenience whatsoever.

 

[ccfccp]

"Health care providers should have a flat, set fee for their services, rather than charging different amounts depending on who is responsible for payment,"

I actually agree with this statement. I think part of the problem with the healthcare system as a whole is the separation of cost and consumer (or patient, as the case may be...) It's impossible to know how much a given test costs, because there is no logic in it. I understand it allows cost sharing for the uninsured, but there are plenty of ways to do that without arbitrarily changing prices.

It's the rest of the article that is ridiculous (ie... phyisicans wouldn't be allowed to bill the full cost of procedures... only what insurance companies pay.) That only works if insurance companies pay 100% of the bill. Most policies I know (including my own) don't tend to do cover 100%. Getting rid of balanced building is basically a back door into stating that insurance companies completely get to mandate prices because physicians have no recompense if the price goes down. Who says a colonoscopy shouldn't be reimbursed for a dollar? What are you going to do then if you can't charge the remainder of the bill to the consumer?

 

[JackADeli]

"Health care providers should have a flat, set fee for their services, rather than charging different amounts depending on who is responsible for payment,"...

I actually agree with this statement. I think part of the problem with the healthcare system as a whole is the separation of cost and consumer (or patient, as the case may be...) It's impossible to know how much a given test costs, because there is no logic in it...

I agree the seperation of product end-user from product cost is a major hurdle that skews the entire system. I also understand the philosophy/thought process that all things being equal, the cost of a lap chole should not be different based on if you have private self pay vs Aetna vs BCBS. But, I also understand that if a large corporation buys 20 econoline ford vans a year, they are likely to get each of those vans at a lower price then the individual buyer that purchases one van per year.

...Absolutely absurd. By this logic, I should be able to walk into a luxury car dealership and demand that they sell me a Ferrari for the price that my neighbor paid for his Honda...

One of the big issues is not just the cost between payers. It is the idea that a ~lap chole on a 5ft 300 pound diabetic with CHF and in the hospital for over a week should pay the same as the over night, healthy 35 year old. Or, that every patient should get the Ferrari, next gen technology operation, i.e. MIS but pay the same or less then the standard open procedure, etc.... That is the problem with the idealist/utopian/socialists sales pitch to the masses. They convince everyone their right is to have Ferraris for everyone. That is not the reality. Instead there are less Ferraris and less hondas. Those in high, privileged political office still get private jets and Ferraris but paid for by the tax payers. The vast masses get less and have no real hopes of getting to the Ferrari level.

The other spectrum of the socialist sales pitch is that it is just a sales pitch. They sell the fantasy of "Ferraris for all" to recruit the masses. In reality, they think there are too many Ferraris and they want NO ferraris. They just sell the facade to get everyone on-board and then cut off all privilege... again, with exception of the high end politicals. That's why they have such funny math. They campaign on all these great "free" benefits for everyone. When cornered, they can't give you a straight answer on how or who will pay for it. If pushed, they claim the "wealthy" and high earners will pay for it cause they can afford the increased tax rates. Their math unrealistically presumes all these "wealthy" will continue to work at same rates, with same income levels, to predict same dollars of tax revenue based on these unchanged income levels. They then also must start confiscating lands and properties via inheritance taxes.... It is all a fundamental social scam.

True socialists/communists/etc... understand this and rarely will tell it to people straight or engage open honest dialogue. They know that if they did, people wouldn't buy it.

 

[deleted87716]

"Health care providers should have a flat, set fee for their services, rather than charging different amounts depending on who is responsible for payment"

Um...we already do. Doctors are required by law to have a single fee schedule. We typically never get to collect our full fee, however, thanks to third-party payer contracts. Insurance companies and discounted-fee-for-service have created the current situation, not doctors.

The solution, ironically, would be to allow all doctors to balance-bill everyone, regardless of whether or not they're in-network. That way, there really would be price transparency, as well as true price competition in the marketplace.

People who are opposed to balance-billing usually don't understand it.

 

[MOHS_01]

I actually agree with this statement. I think part of the problem with the healthcare system as a whole is the separation of cost and consumer (or patient, as the case may be...) It's impossible to know how much a given test costs, because there is no logic in it. I understand it allows cost sharing for the uninsured, but there are plenty of ways to do that without arbitrarily changing prices.

It's the rest of the article that is ridiculous (ie... phyisicans wouldn't be allowed to bill the full cost of procedures... only what insurance companies pay.) That only works if insurance companies pay 100% of the bill. Most policies I know (including my own) don't tend to do cover 100%. Getting rid of balanced building is basically a back door into stating that insurance companies completely get to mandate prices because physicians have no recompense if the price goes down. Who says a colonoscopy shouldn't be reimbursed for a dollar? What are you going to do then if you can't charge the remainder of the bill to the consumer?

Balance billing is not allowed if a provider is contracted with the third party insurer currently. All that one has to do in order to avoid balance billing is to see a participating provider.

The statement quoted above is targeting the differential in payment between different payer "classes" -- i.e., differences in the (discounted) contracted rates. It could also be leveraged into a backdoor method for the implementation of a single payer system.

 

[docB]

We talked about balance billing at length in this thread here.

As an ER doc I have pretty strong feelings against curtailment of balance billing as you'll gather if you read the thread.

I will say that in addition to ER docs the ones who will get hurt are the specialists and admitting docs who take ER call. If you're a cardiologist and you cath a patient who is out of network and their plan (that they negotiated with some group of cardiologists somewhere else) pays $100 for that service you're stuck with it.

 

[LeemerDO]

It's frustrating to see people try to treat healthcare as if it was any other kind of business that provides a service. I think this is the only field with a business model where we almost completely rely on the sole discretion and be at the whim of the decisions made by a third party, whether it be insurance or government regulations. It's only fair practice to recoup costs from someone when one payor source is either delaying/denying payment. The service, that being the exam with treatment recommendations most likely has already been rendered. I think patients at times have become too isolated and insulated from the true cost of their medical care. All they see is that after they pay a pittance of a co-pay, if that, they are rewarded with hundreds to thousands of dollars worth of care in return. Win-win for them. Lose-lose big for us.
The patient could always switch insurances, of course, again, unique only to healthcare, a great majority receive insurance through their employers and are therefore stuck with the crappy choices that they have to offer.

I hope the plaintiffs lose. This is key to the viability of everyday medical practices everywhere.

 

[Impromptu]

I hope the plaintiffs win.

Cash payers should pay the least, right? Ha! Not how the hospitals work. I had a little 45 minute surgery. The hospital charged me $7000 for it. However, I had insurance, which had a negotiated rate of $900, of which I paid $200 for a co-pay (tier 2). Had I been a straight cash payer, they would have pursued me for that $7000. I asked up front how much this would cost. No one was able to even give me a ballpark figure.

The people without work or the working-poor are also the least likely to be able to pay, yet they are the ones charged 7X as much, their bills sent to collection agencies, and they often go into bankruptcy. I believe the insurance companies have too much power. They demand deep discounts from the 'cash' rate. If a doctor decides for charity care to decrease a cash payers rate down to the insurance rate, then the contracts demand that the insurers pay even less to maintain their discount. The origin of discounts to insurance companies came about from insurers guaranteeing a certain number of patients coming into the doctor's office, but that has been done away with a long time ago. Now they only demand discounts, (and they control if they pay.)

What about trying to do research before having surgery or a lab test performed?

Last year I had a simple foot x-ray ordered from my physician. I got it done at the hospital connected to the doctor's office building. At the check-in window I asked the lady if my insurance was going to cover this. She assured me that it would. I asked her to check with her billing friend nearby, just to be sure, and she also assured me that it was covered. A month later a large bill came to my house for the x-ray. Apparently the insurance company didn't cover it. Calling the hospital billing unit, they told me I had to talk with my insurance company. The insurance company told me I had to talk with the hospital.

This opacity in pricing is in the insurance companies benefit. The patients don't know the true cost. The doctors can't fight against it. Only the insurance companies benefit.

I hope this plaintiff wins. Transparency and consistency (between payers) in pricing (including medicare and medicaid) would do wonders for our country. Of course charge more for an appendectomy on a pt with CHF and DM and emphysema, but make the payments the same, no matter if insurer or cash payer.

 

[MOHS_01]

I hope the plaintiffs win.

Cash payers should pay the least, right? Ha! Not how the hospitals work. I had a little 45 minute surgery. The hospital charged me $7000 for it. However, I had insurance, which had a negotiated rate of $900, of which I paid $200 for a co-pay (tier 2). Had I been a straight cash payer, they would have pursued me for that $7000. I asked up front how much this would cost. No one was able to even give me a ballpark figure.

The people without work or the working-poor are also the least likely to be able to pay, yet they are the ones charged 7X as much, their bills sent to collection agencies, and they often go into bankruptcy. I believe the insurance companies have too much power. They demand deep discounts from the 'cash' rate. If a doctor decides for charity care to decrease a cash payers rate down to the insurance rate, then the contracts demand that the insurers pay even less to maintain their discount. The origin of discounts to insurance companies came about from insurers guaranteeing a certain number of patients coming into the doctor's office, but that has been done away with a long time ago. Now they only demand discounts, (and they control if they pay.)

What about trying to do research before having surgery or a lab test performed?

Last year I had a simple foot x-ray ordered from my physician. I got it done at the hospital connected to the doctor's office building. At the check-in window I asked the lady if my insurance was going to cover this. She assured me that it would. I asked her to check with her billing friend nearby, just to be sure, and she also assured me that it was covered. A month later a large bill came to my house for the x-ray. Apparently the insurance company didn't cover it. Calling the hospital billing unit, they told me I had to talk with my insurance company. The insurance company told me I had to talk with the hospital.

This opacity in pricing is in the insurance companies benefit. The patients don't know the true cost. The doctors can't fight against it. Only the insurance companies benefit.

I hope this plaintiff wins. Transparency and consistency (between payers) in pricing (including medicare and medicaid) would do wonders for our country. Of course charge more for an appendectomy on a pt with CHF and DM and emphysema, but make the payments the same, no matter if insurer or cash payer.

I hate to be Captain Obvious... but your argument does not follow. IF you want everyone to be charged -- and responsible for -- the same amount, you are making the argument for balance billing (unless, of course, you want Medicaid for all and to be a government serf).

 

[deleted87716]

I hate to be Captain Obvious... but your argument does not follow. IF you want everyone to be charged -- and responsible for -- the same amount, you are making the argument for balance billing (unless, of course, you want Medicaid for all and to be a government serf).

That's the point I was trying to make before. Also, as I noted, the people who tend to oppose balance billing don't really understand it.

In a perfect world, we could all advertise our fees and collect exactly that amount, whether from the patient alone or from a combination of third-party reimbursement and balance billing. If it wasn't for all of the third-party shenanigans we have to put up with, fee schedules would more accurately reflect the true cost of providing services.