Patient first law

[anbuitachi]

Saw this on facebook. curious if anesthesiologists in Mass are affected by this /how are you taking it? Massively ridiculousness

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[chessknt]

Seems like complete bull**** to me. The provider needs to know how much their insurance is going charge? Why isn’t it the insurance company’s job to do this instead? Seems pretty classic for the legislators bought and paid for by the fat insurance companies trying to make all the dumb****ery of our medical system look like it is the doctors fault instead of theirs. Couple this with illegal balance billing we might as well just convert to socialized medicine we’d make more money since we wouldn’t need to pay billers and they can get mad at the government if it costs too much.

 

[coffeebythelake]

Signed Jan 2021 do it's been law for a year already?

 

[propofabulous]

Signed Jan 2021 do it's been law for a year already?

Signed Jan 2021 to take effect starting Jan 1 2022 (and penalties start in July 2022)

 

[coffeebythelake]

Signed Jan 2021 to take effect starting Jan 1 2022 (and penalties start in July 2022)

But presumably healthcare workers in MA have been talking about this and fighting this for thr past year after it was signed

 

[DirtDocMD]

So it’s up to the “Healthcare provider” to give pricing up front??? Is the “healthcare provider” the PHYSICIAN (I’m assuming) or the FACILITY??

So now a Doc has to give a written estimate, like he’s an auto mechanic, on things he may not even be responsible for providing (he doesn’t provide/charge for the “hospital services”)???

Seems like this burden should be on hospitals/surgery centers/free-standing ER’s, or the INSURANCE COMPANY, NOT the physician...

 

[chessknt]

So it’s up to the “Healthcare provider” to give pricing up front??? Is the “healthcare provider” the PHYSICIAN (I’m assuming) or the FACILITY??

So now a Doc has to give a written estimate, like he’s an auto mechanic, on things he may not even be responsible for providing (he doesn’t provide/charge for the “hospital services”)???

Seems like this burden should be on hospitals/surgery centers/free-standing ER’s, or the INSURANCE COMPANY, NOT the physician...

Come now, auto mechanics and plumbers are held to a lower standard because things can pop up when they are fixing your stuff, like finding out you are a doctor. Much more complicated than surgery.

 

[Neopolymath]

Come now, auto mechanics and plumbers are held to a lower standard because things can pop up when they are fixing your stuff, like finding out you are a doctor. Much more complicated than surgery.

This is why I get an itemized quote before people come to my house. I tell them we can discuss adjustments as needed with justification no problem. This is particularly important for docs who get lawn care or get their deck built etc. The price differences are comical based on curb appeal of the house even if the grass is the same sq ft and the deck is the same size.

 

[coffeebythelake]

My insurance card says it doesn't guarantee health coverage. So many different health insurances, companies, different copays, coinsurances, coverage and noncoverage. Seems like this should be the insurance company's responsibility since they dictate the terms.

 

[nimbus]

So it’s up to the “Healthcare provider” to give pricing up front??? Is the “healthcare provider” the PHYSICIAN (I’m assuming) or the FACILITY??

So now a Doc has to give a written estimate, like he’s an auto mechanic, on things he may not even be responsible for providing (he doesn’t provide/charge for the “hospital services”)???

Seems like this burden should be on hospitals/surgery centers/free-standing ER’s, or the INSURANCE COMPANY, NOT the physician...

Maybe the doctor is only responsible for estimating their own professional fees. This would not be hard to do. In fact, we do this all the time for our cash pay patients and offer a discount to patients who want to pay ahead of time. I don’t see how a doctor can predict facility fees. A CABG can have a 1day ICU stay or a 10 day ICU stay if things don’t go smoothly.

 

[chessknt]

Maybe the doctor is only responsible for estimating their own professional fees. This would not be hard to do. In fact, we do this all the time for our cash pay patients and offer a discount to patients who want to pay ahead of time. I don’t see how a doctor can predict facility fees. A CABG can have a 1day ICU stay or a 10 day ICU stay if things don’t go smoothly.

I think it is really kind of you to assume that the people who wrote the law have any idea how medical billing or fees work.

 

[ambiturner]

I think it is really kind of you to assume that the people who wrote the law have any idea how medical billing or fees work.

The person that wrote it may very well have been an insurance or mega-hospital lobbyist! But the people that voted for it definitely knew nothing.

 

[Neopolymath]

Maybe the doctor is only responsible for estimating their own professional fees. This would not be hard to do. In fact, we do this all the time for our cash pay patients and offer a discount to patients who want to pay ahead of time. I don’t see how a doctor can predict facility fees. A CABG can have a 1day ICU stay or a 10 day ICU stay if things don’t go smoothly.

They could use 5 boxes of tissues instead of 3. That's about $1k difference in price right there! No one knows.

 

[GassYous]

They could use 5 boxes of tissues instead of 3. That's about $1k difference in price right there! No one knows.

That's a lot of baitin

 

[Neopolymath]

That's a lot of baitin

I was thinking they got the Rona for free during their stay as a complimentary gift but sneezed more than the allowed 4 sneezes so they got the surcharge. But that works too.

 

[BLADEMDA]

This law won't affect a lot of us as we must be In-Network with any facility we work at. There is no out of network billing any longer without informing the patient in advance of the surgery.

As for telling the patient their "cost" that is based on the contracts with the insurance companies. This means if you are out of network the patient may not even need to pay their copay to you if you don't disclose the cost to the patient (based on the Mass. law).

I had an in-law go for an EGD/Colonoscopy at an in-network hospital in December. The insurance covered everything but the anesthesia was out of network. The bill was $1900 for the anesthesia but the group reduced it to $900 after the patient complained. That can no longer happen and I think the new law (not the Mass law) is an overall positive for patients.

 

[anbuitachi]

This law won't affect a lot of us as we must be In-Network with any facility we work at. There is no out of network billing any longer without informing the patient in advance of the surgery.

As for telling the patient their "cost" that is based on the contracts with the insurance companies. This means if you are out of network the patient may not even need to pay their copay to you if you don't disclose the cost to the patient (based on the Mass. law).

I had an in-law go for an EGD/Colonoscopy at an in-network hospital in December. The insurance covered everything but the anesthesia was out of network. The bill was $1900 for the anesthesia but the group reduced it to $900 after the patient complained. That can no longer happen and I think the new law (not the Mass law) is an overall positive for patients.

900 is not bad

 

[BLADEMDA]

900 is not bad

1. The person thought anesthesia was in-network and the co-pay was $50
2. $900 is a lot when your salary is $30,000 per year.
3. The group has an exclusive contract with the hospital, which is in-network, yet refused to be in-network itself.
4. This is no longer permitted

 

[GassYous]

900 is not bad

1900 for an egd is absurd.
When you have insurance any payment is ridiculous
I wouldn't pay 900 for anesthesia for a gi procedure

 

[anbuitachi]

1900 for an egd is absurd.
When you have insurance any payment is ridiculous
I wouldn't pay 900 for anesthesia for a gi procedure

maybe not for a egd/colon. but a lot of GI procedures take a lot of time (here at least). once we had a ESD/EMR that took 20 hours !

 

[chessknt]

This law won't affect a lot of us as we must be In-Network with any facility we work at. There is no out of network billing any longer without informing the patient in advance of the surgery.

As for telling the patient their "cost" that is based on the contracts with the insurance companies. This means if you are out of network the patient may not even need to pay their copay to you if you don't disclose the cost to the patient (based on the Mass. law).

I had an in-law go for an EGD/Colonoscopy at an in-network hospital in December. The insurance covered everything but the anesthesia was out of network. The bill was $1900 for the anesthesia but the group reduced it to $900 after the patient complained. That can no longer happen and I think the new law (not the Mass law) is an overall positive for patients.

Of course the pro insurance profit anti balance billing law is good for patients—they get to benefit from rock bottom “median” rates enforced by insurance conglomerates while paying ever higher premiums that get to go directly to the health insurance executives bonuses instead of providers. If they passed a law saying healthcare workers can’t be paid higher than minimum wage that would be great for patients too, even cheaper health care.

Keep in mind that the anesthesia fee from a private insured patient balances out the garbage government insurance rates. I get paid about $150 for a 1.5 hour complicated bronch Ebus biopsy for a patient on Medicaid, less than a fifth of what private insurance pays on average, I’m sure anesthesia gets Something similar. Makes me not want to do them on people with ****ty insurance I’d rather just be at home.

 

[GassYous]

maybe not for a egd/colon. but a lot of GI procedures take a lot of time (here at least). once we had a ESD/EMR that took 20 hours !

???
what

 

[Arch Guillotti]

maybe not for a egd/colon. but a lot of GI procedures take a lot of time (here at least). once we had a ESD/EMR that took 20 hours !

What is that?

 

[coffeebythelake]

maybe not for a egd/colon. but a lot of GI procedures take a lot of time (here at least). once we had a ESD/EMR that took 20 hours !

it took 20 hours for an EMR? wtffffff your GI docs aren't doing it right

 

[anbuitachi]

it took 20 hours for an EMR? wtffffff your GI docs aren't doing it right

i hear we didnt even get paid by medicaid for that case since ny medicaid doesnt pay for long cases

 

[coffeebythelake]

i hear we didnt even get paid by medicaid for that case since ny medicaid doesnt pay for long cases

Your GI docs ought to be refusing these cases, or paying for the anesthesia out of their earnings

 

[nimbus]

900 is not bad

Egd’s are usually 10min cases. $900 is absurd.