{"id":1147,"date":"2019-12-14T11:22:36","date_gmt":"2019-12-14T18:22:36","guid":{"rendered":"http:\/\/danschmidtforsenate.com\/blog\/?p=1147"},"modified":"2019-12-14T11:22:36","modified_gmt":"2019-12-14T18:22:36","slug":"surprise-medical-bills","status":"publish","type":"post","link":"https:\/\/danschmidtforsenate.com\/blog\/?p=1147","title":{"rendered":"Surprise Medical Bills"},"content":{"rendered":"\n
\"\"
From Callegari Berville Grey<\/figcaption><\/figure>\n\n\n\n

The ambulance has brought you to the closest emergency room\nafter you collapsed eating your cheeseburger. The EMTs got your heart going\nagain but your sweat soaks through your Seahawks sweatshirt and it feels like\nthere is a chain binder wrapping your chest. The ER is a blur; a too young\ndoctor asks you too many questions and tells you he will \u201cship you out\u201d, like\nyou are freight. But he made your pain feel better.<\/p>\n\n\n\n

The drugs made you miss the view from the expensive\nhelicopter ride. The next thing you know you are talking to a nice nurse in the\nCCU after your heart \u201cprocedure\u201d. <\/p>\n\n\n\n

Sounds like a success doesn\u2019t it? You are alive to get\nanother cheeseburger. <\/p>\n\n\n\n

Then the bills start showing up. No worries, you have good\nhealth insurance. At least that\u2019s what your employer says. Sure, there will be\na deductible, and some co-pays, but \u201cLordy, what\u2019s this?!\u201d It\u2019s a $30,000 bill\nfrom the cardiologist that was \u201cout of network\u201d. Then there\u2019s $10,000 from the\nanesthesiologist, also out of network. If the hospital was also \u201cout of\nnetwork\u201d that bill will be six figures easy. <\/p>\n\n\n\n

Why didn\u2019t you ask the nice young doctor that was giving you\ndrugs in the ER to send you to only \u201cnetwork\u201d providers? And just what is a\nnetwork?<\/p>\n\n\n\n

Health insurance companies have strategies for cutting costs\nand one is to contract with specific providers for specific fees. They call\nthose providers their network. If you stay within their network then their\nnegotiations help them charge you less. You go out of network, the unnegotiated\npayments become a big risk to them. So, they pass that risk on to you by \u201cout\nof network fees\u201d. <\/p>\n\n\n\n

The size of each insurance companies network changes from\nyear to year, the fees they pay to providers varies annually, and the out of\nnetwork fees also change.<\/p>\n\n\n\n

There is no available data for how often these \u201csurprise\nbills\u201d happen in Idaho. We\u2019re small potatoes (but really famous potatoes) to\nthe health care insurance industry. Estimates for other state show 25% of emergency\nvisits have some \u201csurprise\u201d.<\/p>\n\n\n\n

The ACA kind of addressed this, but not quite. It required some\ninsurance companies to pay out of network providers the median of what it paid\nin network for the same services. But it didn\u2019t prohibit balance billing; that is,\nthe insurance company might pay some, but you get the bill for the balance.\nAnd, the insurance company didn\u2019t negotiate a lower charge from the provider,\nso, you will owe.<\/p>\n\n\n\n

Some states have jumped in to try to address this. Idaho is\nnot one of them, though a bill was introduced in 2018. It went in a drawer. But\nstate by state solutions might not apply to all the large employer-based\ninsurance companies.<\/p>\n\n\n\n

President Trump called for fixing this last May. That was\nbefore he called the new President in Ukraine. <\/p>\n\n\n\n

But guess what? Even though congress is \u201cbitterly divided\nalong partisan lines\u201d, they seem to be able to agree on fixing this. There are\nat least three bills floating through the halls, and as of Sunday, it looks\nlike one might pass. This is despite a multi-million-dollar dark money effort\nby private equity fund backed physician groups to scuttle the effort. <\/p>\n\n\n\n

This seems like a small leak in the dike we ought to plug\nup. It\u2019s a simple solution to a simple problem, right?<\/p>\n\n\n\n

I\u2019m sorry; the tide is rising and we have a health care\nsystem that loves that it is now almost one fifth of our Gross Domestic\nProduct. Plugging this leak might protect the recently recovered from having\nanother heart attack when they open their mail, but it won\u2019t stop the rising\ntide of health care costs by itself.<\/p>\n\n\n\n

Just as hospitals have learned how to cost shift what they\nlose on Medicare and Medicaid patients onto private insurers, just as doctors\nhave learned how to up-code their services, just as health insurance companies\nhave seen their stock values double in the last three years, I fear we are\ngoing to get soaked even if we plug this leak. We have to turn the tide.<\/p>\n","protected":false},"excerpt":{"rendered":"

The ambulance has brought you to the closest emergency room after you collapsed eating your cheeseburger. The EMTs got your heart going again but your sweat soaks through your Seahawks sweatshirt and it feels like there is a chain binder … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8],"tags":[],"_links":{"self":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1147"}],"collection":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1147"}],"version-history":[{"count":1,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1147\/revisions"}],"predecessor-version":[{"id":1149,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1147\/revisions\/1149"}],"wp:attachment":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1147"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1147"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1147"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}