Doctors and insurers use patients as human shields in billing cases – HoustonChronicle.com

Doctors and insurance companies have proven they are more than willing to use patients as human shields. Our elected representatives must intervene.

The battle is over money, with doctors and hospitals charging higher prices and insurance companies denying more claims. Providers don halos claiming purity of spirit while running up ridiculous bills, while claims adjusters with green eyeshades scoff at what they consider borderline fraud.

One claims to heal your body, the other claims to protect your money. But both will bankrupt you in a heartbeat rather than compromise with the other.

My colleague Jenny Deam is digging into the building blocks of the health care business by examining the billing codes used by doctors and hospitals. This past week, she wrote about how emergency room doctors overbill unsuspecting patients with minor problems by using codes reserved for life-threatening conditions, an abuse of discretion and our trust.

A free-standing ER billed Sarah Hirsch more than $15,000 for fluid in her ears. A large hospital ER billed Richard Kelley $1,188.75 for walking through the door to have a day-old cut looked at. A small hospital ER charged a $1,706.19 facility fee to get a tetanus shot.

An abundance of caution is the first excuse doctors and hospitals offer. That CAT scan performed at the hospital ER was necessary to ensure the problem wasn’t more severe, even if it cost twice as much as a CAT can at a freestanding imaging center.

The second excuse for the big bill is that insurance companies are cheapskates. Doctors and hospitals say they must overcharge and collect from someone because insurance companies pay such a small fraction of the bill.

Insurance executives, meanwhile, have watched health care providers send more and more bills coded as emergencies, even though the number of visits has remained flat. If insurance companies pay all of these crazy bills, the cost of health insurance will skyrocket beyond what the average American can afford.

After writing about Texas health care for the last seven years, I know these arguments by heart. I also know the horror stories.

Too many health plans have networks so narrow that finding a doctor who will accept a new patient is nearly impossible. Some insurers will not pay for life-saving treatments because a drug is either experimental or not on a list of approved medications. Insurance companies intentionally exclude some doctors and hospitals so patients will go somewhere cheaper.

Then there are the doctors who see a patient with good insurance as a cash cow. Big practice groups expect doctors to hit billing goals every quarter, so they order extra tests, send patients to imaging centers within the practice and use the most extreme codes to bring in the most money.

Until someone needs extensive health care services, most people have no idea the financial minefield they will navigate. Everyone wants to talk about how to make you better, but no one will give you a straight answer about what it will cost.

Which brings me to the third excuse trotted out by healthcare professionals. Neither the doctor nor the hospital wants to discuss money because they do not want patients making healthcare decisions based on financial considerations.

Free-standing ERs will not tell a potential customer that they are out-of-network because they are worried a person with a severe health problem will do an about-face and go somewhere else. Several doctors claimed that since federal law requires an ER to accept all patients, law enforcement could decide that disclosing the truth about billing is tantamount to turning patients away.

None of these excuses, though, solve the problem of patients receiving monstrous bills they cannot afford. None of these excuses did anything to help Melissa Welch-Latronica, a single mother in Illinois thrown in jail this month for a warrant issued after she failed to pay an ambulance bill.

Luckily, President Donald Trump and Sen. Lamar Alexander, the Republican chairman of the Health, Education, Labor and Pensions Committee, have promised to tackle health care billing practices this year.

Proposed bipartisan legislation would bar doctors and hospitals from billing a patient for the remainder of a bill when the insurance company doesn’t pay. Providers would have to take it up with the insurer, which would have to pay in-network rates.

The proposed law would also require hospitals to notify ER patients, once they are stabilized, that the facility is out-of-network and give them the option of getting treated elsewhere.

This legislation is common sense, and everyone who might need a doctor someday should support it. Even if the doctors and insurers don’t.

Source: Doctors and insurers use patients as human shields in billing cases – HoustonChronicle.com