Top Stories about Medical Billing Industry
Medical Billing, a world of hurt: Healthcare centers replace private practice doctors that increase the cost for patients on insurance plans as well these days more and more doctor’s visits are at one of a growing number of “off-campus” health centers, which bill patients for “outpatient hospital visits,” a designation that brings higher payments from Medicare and private insurers for the same services performed in a “doctor’s office” visit.
The change didn’t notice because Medicare covers most of the charges at off-campus hospital departments. These changes can be expensive for younger people with high-deductible private insurance plans because there are usually two separate charges—one for the doctor often charged at a higher hospital rate and another for the space used to treat a patient, known as “facility fee”.
This dual bill charges cost two, three, or four times more costly for patients for a single treatment—all for basically the same care.
That’s designation also means that many patients are paying more out of their pockets for high deductible insurance plans—sometimes hundreds of dollars are more for routine care.
Patients confused About Hospital Charges:
Pam Semanik said, “It’s crazy”, whose health plan is $1,250 deductible. She says she was left owing about $400 in charges for a pap smear and mammogram.
“I never go to the doctor except for routine stuff,” said Semanik, from Walton Hills. “I shouldn’t have to pay $400 for every visit.”
Sarah Haul said who owed $188 for a shot in April that cost her $12 in the past. The shot was billed as “IV therapy” under “hospital services,” terms that she said she was new to her but that indicate she was billed at a hospital rate. She’s hoping it was just a mistake.
“It was a shot,” she added. “If that’s what it’s going to cost, I won’t do it.”
The shift to billing patients for visits to hospitals instead of doctor’s offices is part of a larger national trend that has been embraced by local health systems, most notably the Clinic, MetroHealth Medical Center and University Hospitals.
“This is happening all over the country, where you have the big hospitals gobbling up the primary-care physicians and expanding it out into the suburbs as a way of feeding into their systems,” said Stuart Altman, an economist, and professor at Brandeis University in Boston. “Also, it allows them to negotiate tougher contracts with insurance companies.”
“It affects health care costs because hospitals charge more and get paid more, if you have a high deductible, you wind up paying the bill.” Added Altman
Altman and others acknowledged that the prospect of people forgoing preventive care could undercut the nation’s primary-care cut effort to catch and treat medical problems early.
Melanie, who lives in California, is one of the patients. After a series of surprise bills from out-of-network ER doctors at otherwise in-network hospitals, she realized the only way to avoid the unexpected sticker shock was to look outside her area for emergency care. “I know that our local hospital doctors do not contract with my insurance,” Melanie tells. “I was having chest pain for several days, and chose to not go to the local hospital but to go one farther away because I had run into issues at the local hospital with balance-billing.”
“Balance-billing” is the practice by which out-of-network doctors will bill patient for the balance that remains after the insurance companies pay out its contractually obligated amount to the hospital.
In California, your protection against balance-billing depends on which type of plan you have and who regulates your insurer. Consumers covered by HMO and PPO insurance plans licensed by the California Department of Managed Health Care are protected from balance-billing for ER visits.
But if the PPO or any other insurance plan is regulated by the California Department of Insurance, state law does not protect an ER patient from balance-billing. This inconsistency in California law leads to some patients erroneously being billed for balances that their HMO should be negotiating. But if you’re like Melanie and your plan is not exempt from balance-billing, it’s up to you to either pay up or try to work out a deal with the doctor.
And in Melanie’s experience that drawn-out, tedious task has led to significant changes for her family and their medical care.
“It’s really changed what we do in emergencies,” she says. “Something we fear constantly is getting hurt locally and having to be transported via ambulance when you do not have control of where they take you. They will go to the closest ER. And that ER for us at home does not have contracted doctors.”
“One of the biggest problems besides time is that to get to the further ER, you need to go on the freeway that is very congested and full of accidents,” she says. “It’s not a safe route. The closer ER is in town and on surface streets.”
