Healthcare Pricing Corruption

The healthcare industry needs to be reformed by the free market.  Patients need be able to pay their own bills in order for the market to properly price healthcare components. The idea that healthcare should be provided to all, even if they cannot or do not pay, was the decision that brought us to our current dilemma.  That notion needs to stop, so that providers are paid by patients.

The Health Care Crusade has attempted to publicize the problem and offer some common sense solutions for Healthcare Law to ensure that providers can’t cheat consumers.  They present the following “new laws” to get the conversation started:

STOP MEDICAL PRICE-GOUGING NOW!

Introduction 

Virtually all health insurance policies today feature higher deductibles, larger co--‐pays, and greater out--‐of--‐pocket limits. These policies are not inherently bad; but often they are sold to persons with modest incomes and no savings, who cannot handle the extra costs if they become sick. We seem to forget that low--‐income people should have low deductibles, not the other way around. As a result, we are headed for more and more collisions between health care providers and patients. The patients either cannot pay their share of medical bills, because they have so little money; or they are unwilling to pay, because

They feel that the charges are too high. Providers will therefore be stepping up their efforts at collection. Patients will be confronted at the clinic, at the reception desk or even in their hospital beds.

The following new laws are a serious effort to protect the patient. The consumer protections which now exist are inconsistent and incomplete. Frankly, this is an economic war. We have to stop the health care industry from extorting incredible sums from the rest of us.

New Law #1 - Hospitals must charge Medicare-like rates to the uninsured. If the Medicare fee for gallbladder removal is $6,000, then the maximum that the hospital can charge should be $6,000 + 20% = $7,200 – not the $30,000 ‘chargemaster’ rate. If the Medicare fee for a colonscopy is $555, then that is the maximum the Hospital can charge should be $555 + 20% = $666 – not the $7,000 ‘chargemaster’ rate. If the Medicare fee for treating a heart attack And implanting a stent is $15,000, then the maximum that the hospital can charge should be $15,000 + 20% = $18,000m – not the $53,000 ‘chargemaster’ rate. The maximum charge for a short--‐stay emergency department visit would be $200, not $1,000. The maximum chargem for a pathologist’s tissue exam would be $128, not $1,800. Section 9007 of The Affordable Care Act did call for restrictions on ‘excessive pricing’ --‐--‐but only in non--‐ profit hospitals, and only for persons with poverty--‐level incomes. To this day, the law has not been enforced. (Though the Department of Justice did have time to fine Google $500 million For running ads from international pharmacies.)

The new Medicare--‐pricing standard must now apply nationwide for anyone who is uninsured, and Must be imposed on all hospitals whether profit or non--‐profit. Seven states do provide some protection right now, but this must be a federal law. (Although some hospitals forgive part or all of their charges if the patient is poor...why not make this a national standard? . . instead of a tortuous, uncertain case--‐by--‐ case determination.) Hospitals must not be allowed to punish ordinary citizens who have the bad luck to become patients. We should not need to buy an expensive insurance policy, just to get a fair price on hospital care. We should not need to sue a hospital, or essentially beg for forgiveness, in order to avoid a crippling debt. American politicians have historically been afraid to confront hospitals. Their alternative is to pretend that we can all get insured, and then the carriers will protect us. This is a forlorn hope.

New Law #2 - Balance billing must be severely restricted for hospital care For example: If the insurer pays $10,000 for a hospital treatment, then that is basically all that the hospital can collect. Once a hospital accepts insurance reimbursement, it cannot pursue the patient for extra charges, other than the patient’s deductible and coinsurance. This will be true across the board for

Emergency admissions. For elective, non--‐emergency admissions, balance billing can only occur if the patient is clearly warned in writing And signs off, in writing, preferably after an attorney’s review at least 15 days in advance of their admission. (Massachusetts recently passed a disclosure law that moves in the right direction.) In addition: If the hospital uses an ‘out--‐of--‐network’ surgeon, that doctor must accept the insurance company’s fee schedule as payment in full. (This includes radiologists, anesthesiologists, pathologists, as well as surgeons.) An out--‐of--‐network doctor, working in a hospital where the patient has no choices, cannot charge forty times  the Medicare fee for his services. (Well, he can charge it, but under our laws he cannot collect it.)

The hospital will be required to hold the patient harmless, for any amounts charged in excess of network rates. Billing disputes between hospitals and ER doctors must resolved by the parties, with no balance billing to the patient. In addition: No extra bills will be allowed for ambulance rides. (In fact, federal funds should be allocated to make ambulances a free public good. Thirty years ago most cities provided ambulance service from municipal taxes.)

An insured patient will only owe their deductible and co--‐insurance – Regardless of networks. For example:

o Say that you have surgery in a hospital, and a non--‐network anesthesiologist is utilized.

o He sends a separate $12,000 bill for two hours of his services.

o Your insurance plan pays their standard fee of $1,500.

o Under our law, neither the doctor nor the hospital can bill you for the difference.

o The anesthesiologist should in fact be ashamed of himself, and in a better world (like Canada or Germany) they would be disciplined by a peer group like the AMA. Another example:

o While hospitalized, you have a colonscopy and endoscopy, due to a risk of cancer.

o The provider charges $6,000.

o The insurer pays $2,000, which is their standard amount and is actually 150% of Medicare’s rate.

o Your deductible is $1,000 and you have a 20% coinsurance after that.

o You owe $1,000 plus 20% of $2,000 or $400, for a total of $1400.

o You would never owe 20% of $6,000, in or out of network.

o The provider has to “eat’ the rest of their fee. It is impossible for a person who is hospitalized to form contracts at that time.

Balance billing for inpatients puts vulnerable people at risk when they have no real choice about treatment. For years, new patients have been required to sign a guaranty agreement to pay any hospital costs that their insurer does not cover. Such blanket authorizations are signed under duress and should be unenforceable.

New Law #3 - If an insurance claim is denied, the patient is not liable.

It will become the provider’s responsibility to check with the insurer before providing care. (This is the basic rule in Medicare today.) If the provider guesses wrong as to insurance coverage, they cannot overbill the patient to make up the difference. The patient must be held harmless in disputes between providers and insurers about ‘medical necessity’ or ‘reasonable and customary fees.’

If a hospital charges $250,000 for care that costs them $50,000 to provide, and the insurer refuses to pay, the hospital cannot threaten the Patient with lawsuits, property seizure, or wage garnishment. NOTE: At the same time, there are some insurers who refuse to pay pre--‐approved claims, or pay very slowly. They pretend to lose registered mail, or assert that provider information is missing, or dispute claims that are identical to what has been paid in the past.

The patient must also be held harmless in those cases; the answer is tougher regulation by state commerce departments. In extreme cases, the government must have the right to seize the insurer and fire all its officers.

Source: The Health Care Crusade

Comments

Free market healthcare will deliver better healthcare than government paid healthcare. We need a “Kelly Blue Book” for healthcare procedures and drugs to know if we are being cheated.

Norb Leahy Dunwoody GA Tea Party Leader