Wednesday, February 18, 2015

Hidden Providers Still Exist

Hidden providers are not new to health insurance. They have been around as long as there has been
managed care. We have posted on the hidden provider issue here several times, but apparently we still need to get the word out.

Pam Durocher is a breast cancer survivor.

That's a good thing.

When looking for a surgeon for reconstructive work she used her carrier's provider search tool to look for par providers.

But she wasn't thorough in her search.
Like Durocher, many consumers who take pains to research which doctors and hospitals participate in their plans can still end up with huge bills. Sometimes, that’s because they got incorrect or incomplete information from their insurer or health-care provider. Sometimes, it’s because a physician has multiple offices, and not all are in network, as in Durocher’s case. Sometimes, it’s because a participating hospital relies on out-of-network doctors, including emergency room physicians, anesthesiologists and radiologists. 
Consumer advocates say the sheer scope of such problems undermine promises made by proponents of the Affordable Care Act that the law would protect against medical bankruptcy. - The Daily Beast

Consumer advocates need to stick with something they understand. Obamacrack did nothing to "protect consumers against medical bankruptcy."

If anything, it made it worse.

Because of cost constraints placed on carriers, shortened enrollment periods and planned obsolescence of existing health insurance policies it is more difficult for consumers to understand their options and how these new plans work.

Telling voters that buying health insurance will be as easy as purchasing an airline ticket online and allowing health insurance to be peddled by navigators and social workers has only made matters worse.

“It’s not fair and probably not legal that consumers be left holding the bag when an out-of-network doctor treats them,” said Timothy Jost, a law professor at Washington and Lee University.

One must assume that Prof. Jost has never practiced law in the real world.

Perhaps Jost should revisit contract law 101.
Efforts by doctors, hospitals and other health providers to charge patients for bills not covered by their insurers are called “balance billing.” The problem predates the federal health law and has long been among the top complaints filed with state insurance regulators.
The federal health law largely sidesteps the issue as well. It says insurers must include coverage for emergency care and not charge policyholders higher copayments for ER services at non-network hospitals, because patients can’t always choose where they go. While the insurer will pay a portion of the bill, in such cases, doctors or hospitals may still bill patients for the difference between that payment and their own charges.

Yes, and it has always been that way, even before Obamacrack.

No fear.

Legislators have a "fix" for these problems. Effectively eliminate managed care networks.
If regulators required them to fully cover charges by out-of-network doctors, that could reduce “incentives for providers to participate in networks” and make it harder to have adequate networks, America’s Health Insurance Plans, the insurers’ trade group, and the Blue Cross Blue Shield Association wrote in a joint letter to the NAIC.
It would also raise premiums.
Instead, AHIP says, states could require out-of-network doctors to accept a benchmark payment from insurers, perhaps what Medicare pays, rather than balance billing patients.

Yes, but Medicare almost always pays a lower reimbursement than private health insurance.

Ronald Reagan pegged it when he said "I'm from the government and I am here to help you.".

It used to be said the only thing the government can manage correctly is a war.

Now they can't even get that right.
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