Question for anesthesia docs re surprise billing bill

[Baggend]

---

Members don't see this ad.

Question for you guys, I am not anesthesia, I am EM.

What are your guys thoughts on the surprise bill that is moving its way across congress?
What's the ramification of no more OON billing for your services?

Just wondering, thx

 

[kmurp]

We participate with virtually all insurance plans now. The scary potential would be the possibility of difficult contract negotiations in the future. If one can’t opt out of an egregious contract, that would be a problem.

 

[Baggend]

We participate with virtually all insurance plans now. The scary potential would be the possibility of difficult contract negotiations in the future. If one can’t opt out of an egregious contract, that would be a problem.

Yes that's a problem I foresee too.

 

[deleted941485]

Basically anyone who practices in the hospital and sees a patient is screwed. The whole thing was a gimmie for insurance cos and hospitals. You will get the crappiest rates unless you join mega Med Corp.

 

[Mikkel]

Thanks to the jagbag mega corporations that intentionally go out of network to squeeze patients and hospitals, honest groups will suffer, because they'll bear the brunt of this proposed legislation in that they won't be able to negotiate fairly. The insurance companies would be given all the power... If you don't like their contract, then good luck, you'll just be stuck with the median rates in the community.

This is a way for the government to start price fixing, and it's going to result in pay more in line with Medicare/Medicaid when it all reaches equilibrium.

Insurance companies will probably see the biggest benefits. More bonuses for the bosses, yay.

 

[deleted941485]

Thanks to the jagbag mega corporations that intentionally go out of network to squeeze patients and hospitals, honest groups will suffer, because they'll bear the brunt of this proposed legislation in that they won't be able to negotiate fairly. The insurance companies would be given all the power... If you don't like their contract, then good luck, you'll just be stuck with the median rates in the community.

This is a way for the government to start price fixing, and it's going to result in pay more in line with Medicare/Medicaid when it all reaches equilibrium.

Insurance companies will probably see the biggest benefits. More bonuses for the bosses, yay.

Docs need to get out and let their reps know that this is not a road we want to go down this road.

 

[AdmiralChz]

Basically anyone who practices in the hospital and sees a patient is screwed. The whole thing was a gimmie for insurance cos and hospitals. You will get the crappiest rates unless you join mega Med Corp.

Ehhhhh not quite. Hospitals negotiate insurance rates just like individual anesthesia groups and the same downward pressure introduced via this bill would apply.

It’s the rare instance where the AHA (American Hospital administration) is on the same side as the AMA (an organization that is largely useless, IMO, and showed it’s true colors in the initial Obamacare drafts). Only major party “for” the Pallone-Walden bill are the insurance companies. There is widespread speculation that the insurance companies may be able to show how premiums could be decreased in this bill - by way of decreasing your and the hospital’s reimbursement overtime. Pretty much the worst possible way to cut healthcare dollars.

 

[deleted941485]

Ehhhhh not quite. Hospitals negotiate insurance rates just like individual anesthesia groups and the same downward pressure introduced via this bill would apply.

It’s the rare instance where the AHA (American Hospital administration) is on the same side as the AMA (an organization that is largely useless, IMO, and showed it’s true colors in the initial Obamacare drafts). Only major party “for” the Pallone-Walden bill are the insurance companies. There is widespread speculation that the insurance companies may be able to show how premiums could be decreased in this bill - by way of decreasing your and the hospital’s reimbursement overtime. Pretty much the worst possible way to cut healthcare dollars.

Stay away from the hospital. Place is a trap loaded with legal land mines. Unless of course you like working for free.

 

[Arch Guillotti]

Question for you guys, I am not anesthesia, I am EM.

What are your guys thoughts on the surprise bill that is moving its way across congress?
What's the ramification of no more OON billing for your services?

Just wondering, thx

Very problematic.

 

[sum dude]

Question for you guys, I am not anesthesia, I am EM.

What are your guys thoughts on the surprise bill that is moving its way across congress?
What's the ramification of no more OON billing for your services?

Just wondering, thx

Here's a good summary article. If Senate current version passes, expect 15-20% cuts in reimbursement. Anesthesia will be hit hardest (see California). Need to call your legislators, and get House version passed (has dispute resolution, much more doctor friendly).

 

[Mman]

the bill is basically a way for insurance companies to juice their profit margins. Sure they can pass on a small percentage of their decreased cost as lower premiums to patients, but most of it will be pure profit for them. That's why they spend the big bucks lobbying congress.

 

[DM27]

I know very little about it, but I know that any bill with as altruistic sounding a name as that has to be pure evil.

I read that summary article and it was pretty useful. I am overall fairly ignorant when it comes to most of the insurance end of things outside of "more reimbursement for one-lung" or "more money for general + post op block". I was wondering if anyone had any clear answers to a couple questions.

1) What is the practical reason for why a provider in a facility would be out of network when maybe his/her colleagues in the same division are not and why would he/she feel they merit more for reimbursement? It is something as simple as "I operate a neurosurgery practice and I have had numerous disputes with blue cross that my spine surgeries should pay 1.5X instead of X so I am no longer in network with them. So if a patient comes into the hospital when I am on call I want my 1.5X rate because the X rate is rubbish.", or is there a lot more to this reasoning?

2) Has anyone on the anesthesia side here actually sent a patient a bill requesting more money due to insufficient reimbursement when out of network? I had this come up before at a prior job, but I was a hospital employee and I had no knowledge or involvement in any of this billing portion as I was essentially paid a salary, so the bill was either being generated at the department level or more generally at the hospital billing level.

 

[Mman]

I know very little about it, but I know that any bill with as altruistic sounding a name as that has to be pure evil.

I read that summary article and it was pretty useful. I am overall fairly ignorant when it comes to most of the insurance end of things outside of "more reimbursement for one-lung" or "more money for general + post op block". I was wondering if anyone had any clear answers to a couple questions.

1) What is the practical reason for why a provider in a facility would be out of network when maybe his/her colleagues in the same division are not and why would he/she feel they merit more for reimbursement? It is something as simple as "I operate a neurosurgery practice and I have had numerous disputes with blue cross that my spine surgeries should pay 1.5X instead of X so I am no longer in network with them. So if a patient comes into the hospital when I am on call I want my 1.5X rate because the X rate is rubbish.", or is there a lot more to this reasoning?

2) Has anyone on the anesthesia side here actually sent a patient a bill requesting more money due to insufficient reimbursement when out of network? I had this come up before at a prior job, but I was a hospital employee and I had no knowledge or involvement in any of this billing portion as I was essentially paid a salary, so the bill was either being generated at the department level or more generally at the hospital billing level.

if you are out of network, the patient gets a bill for the full charge. They then have to submit that bill to their insurance company for reimbursement. The insurance companies like to then just cut a check to the patient themselves and rely on the patient to send that money to the doc to pay the bill which often doesn't happen. So then the doc has to take them to small claims court to get an award for the money and then possibly send them to collections if they don't pay. It's lovely for all involved.

As for how a physician ends up out of network for an insurer, here's an example. Say you have a procedure you do to patients that CMS pays you $50 for and 3 different private insurers pay you $150 for. A fourth insurer comes in to the area and says they will pay you $100 for it. You are like no way everybody else is paying more. They won't budge. Under the current system you can either accept that $100 (and your other 3 insurers will likely end up dropping down to that rate during your next contract) or you can go out of network and bill the patients the higher amount directly and collect what you can collect. Either the insurer caves because they have so many patients complaining to them or you cave because you can't collect as much as you hoped and are getting too much push back from patients.

The last time we went out of network, we actually collected more money (per unit) than we were asking for in our negotiation. After several months, the insurer realized it was cheaper to just agree to what we had asked for in the first place.

 

[sum dude]

It says in the CBO estimate if Benchmarking passes, PEAR doctors (Path, EM, Anesthesia, Radiology) will take a 20% paycut (probably more if you work for CMG). That's currently in Senate 1895 verson. The House Version, HR 3060, uses IDR for dispute resolution. This will be much more equitable for doctors. This should be medicine's number 1 issue right now, unfortunately too many doctors are asleep at the wheel. People need to call their reps to make sure House version 3060 with Ruiz/Roe ammendment passes or we are all screwed.

We Need A True Market Solution To Fix Surprise Billing in Healthcare

 

[deleted162650]

You mean the RAPE doctors??

 

[Spikebd]

It says in the CBO estimate if Benchmarking passes, PEAR doctors (Path, EM, Anesthesia, Radiology) will take a 20% paycut (probably more if you work for CMG). That's currently in Senate 1895 verson. The House Version, HR 3060, uses IDR for dispute resolution. This will be much more equitable for doctors. This should be medicine's number 1 issue right now, unfortunately too many doctors are asleep at the wheel. People need to call their reps to make sure House version 3060 with Ruiz/Roe ammendment passes or we are all screwed.

We Need A True Market Solution To Fix Surprise Billing in Healthcare

I’m surprised more people don’t seem to be paying attention to this issue. Are all of us physicians just that apathetic and all plan to be employed by businessmen who couldn’t care less about us?