Guerilla Billing – Missing the Gorilla in the Midst

By ANISH KOKA, MD No one likes getting bills. But there is something that stinks particularly spectacularly about bills for healthcare that arrive despite carrying health insurance. Patients pay frequently expensive monthly premiums with the expectation that their insurance company will be there for them when illness befalls them. But the problem being experienced by an increasing number of patients is going to a covered (in-network) facility for medical care, and being seen by an out-of-network physician. This happens because not all physicians working in hospitals serve the same master, and thus may not all have agreed to the in-network rate offered by an insurance company. This is a common occurrence in medicine. At any given time, your local tax exempt non-profit hospital is out of network of some low paying Medicaid plan or the other. In this complex dance involving patients, insurers and doctors, Patients want their medical bills paid through premiums that they hope to be as low as possible, Insurers seek to pay out as little of the premium dollars collected as possible, and Doctors want to be paid a wage they feel is commensurate to their training and accumulated debt. Insurers act as proxies for patients when negotiating with the people that actually deliver healthcare – doctors. Largely, the system works to funnel patients to ‘covered’ doctors and hospitals. Patients that walk into an uncovered facility are quickly redirected. But bre...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Economics Hospitals Medicare Patients Physicians Primary Care The Business of Health Care Source Type: blogs