There has been a lot of focus in the states (particularly the blue ones) to limit billings from providers in cases where a patient is not aware the provider’s services would be out-of-network. So, for example you are hospitalized at an in-network facility and during your surgery a non-network anesthesiologist treats you. Even if you have taken great care to see only in-network doctors, under some plans, you will be billed for out-of-network services. Sounds ridiculous doesn’t it?
Under most employer plans, you can generally get the claims payer to negotiate with the provider – and you certainly would if it was an emergency procedure. But with some plans, for non-emergency care, you can do little except litigate. The providers will come after you with collection actions. Generally, it’s worth the push since the providers would prefer to compromise rather than pay legal fees, but it will be a painful process.
Bipartisan legislation to end surprise medical bills has been introduced. And in addition, the bill would require that all charges related to a hospitalization be included in one consolidated bill. Under the law the out-of-network provider would have to get consent to treat and bill for out-of-network services, or alternatively the amount they can bill would be limited to the in-network reimbursement or the usual and customary amount. It’s about time.
These low-hanging fruit abuses shouldn’t be so hard to correct. Publishing drug prices in advertisements is coming. Hopefully the momentum builds and we can make progress.