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NYTimes- Costs Can Go Up Fast When E.R. Is in Network but the Doctors Are Not

Discussion in 'Emergency Medicine' started by OCDEMS, Sep 28, 2014.


    OCDEMS 2+ Year Member

    Sep 18, 2012
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  3. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner Moderator Physician Faculty 10+ Year Member

    Aug 2, 2006
    Couldn't tell you who my CMG contracts with.
    Remember, this was a big deal in California because EPs are explicitly forbidden for balance billing (the out of network expenses). I expect the same of Texas as more Californians move here and try to make it the same political hellhole they left.
    filhodeinferno likes this.
  4. southerndoc

    southerndoc life is good Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Jun 6, 2002
    It really aggravates me that the father in the article requested a plastic surgeon then snubbed his fees that weren't covered by insurance. He asked for it (the emergency physician didn't request him), so he should be responsible for it.
    RPedigo, SoCuteMD and EM Junkie like this.
  5. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

    May 3, 2004
    I think we shouldnt be mad at our patients. In the end the insurers want to pay us crap. We wont allow it. It is that simple. Medicare/medicaid reimbursement is crap, we see 15% uninsured (national average), so the insurers have to be the ones who we make our profit from. Seems simple. If they paid better we would contract with them all.
  6. GoBuckeyes913

    GoBuckeyes913 Intoxicating 7+ Year Member

    Jan 23, 2007
    For a chin lac. . . They deserve the bill. I'm sure the ED doc tried telling them they would take care of it. You KNOW how that conversation went. I don't feel bad for them. Not even a smidge.
  7. DocEspana

    DocEspana Stabby Stabby. Physician 7+ Year Member

    Mar 1, 2010
    Outer Worlds
    The NYT did a nearly identical story on Friday about this. Friday's was about how a guy getting a spinal stenosis surgery had an in network orthopedic surgeon selected but got separately billed $114,000 for a neurosurgeon he never met who assisted. And the story was about the practice of putting out of network people on the case and simply going after the patient until the patient puts enough pressure on insurance to just pay up the requested amount. It was suggested that there may be some collusion to split the windfall, but no proof that it did happen.
  8. VA Hopeful Dr

    VA Hopeful Dr Senior Member Physician 10+ Year Member

    Jul 28, 2004
    As a non-EM doc who once got a hefty ED bill at my residency hospital (so obviously IN-network)... I'm sorry, you go to the ED you should expect it to be very expensive. Around here, you pay $200 after hours just for the AC guy to show up much less the cost of the actual work. Why should physicians be any different?
  9. MSmentor018

    MSmentor018 Hooah! Physician Faculty SDN Advisor 10+ Year Member

    Jul 9, 2007
    it's always hot!
    agreed, I am sure if it was complicated and outside our scope we'd easily call plastics/ent but if it's simple sutures there's no need for a surgeon. i can only assume the dad was choosing "plastic surgeon" purely for the term. customer service was delivered as requested dad, now pay for it
  10. Birdstrike

    Birdstrike 7+ Year Member

    Dec 19, 2010
  11. EctopicFetus

    EctopicFetus Keeping it funky enough 10+ Year Member

    May 3, 2004
    I will say this. I needed a plumber in the past. Their fees were unreal. Seems like the hourly wasnt terribly less than an average ED doc. However, no med mal, no grad school, no student loans.
  12. sum dude

    sum dude MD Physician 7+ Year Member

    Jun 16, 2009
    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.
    Spikebd likes this.
  13. Birdstrike

    Birdstrike 7+ Year Member

    Dec 19, 2010
  14. Arcan57

    Arcan57 Junior Member 10+ Year Member

    Nov 21, 2003
    Reading the NYT article made me unreasonably angry. Most of the $$$ figures mentioned having nothing to do with what the EP got paid and the one sort of but not really concrete example they did use (>$2K for cardiac monitoring) is so obviously wrong that it calls into question whether the reporter sourced the story using 4chan or reddit. Nevermind that salary is going up because we're working harder (more pts/hr) and longer (more hrs/month) in order to try and plug the gaping hole in our current medical system. "I thought the doctor came with the E.R."... F%^# you!
  15. TooMuchResearch

    TooMuchResearch i'm goin' to Kathmandu... Lifetime Donor Classifieds Approved 7+ Year Member

    Oct 20, 2008
    Townsville, USA
    Why can I only like this once?
  16. e30ftw

    e30ftw peace 5+ Year Member

    Feb 23, 2012
    I seriously lol'd at the kid with 8 stitches whose parent's requested plastics closure and got billed $5k. I mean wtf do you expect a plastic surgeon to bill when he's called to the ED for a chin lac?

    Ms. Rosenthal conveniently left out the hundreds of thousands of dollars in uncompensated care provided yearly by every emergency physician. We get no credit for spending 30 minutes sewing a drunk HIV/HepC chainsawed leg back together at the risk of needle stick for no compensation but are vilified for not controlling the intricacies of medical insurance billing?

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