More Games to Play

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California just passed a law forbidding doctors to bill out-of-network rates for work done in-network.  Wait.  What? Let’s try that again.  The California State Assembly passed a bill which “would forbid ancillary providers from charging patients more than the in-network rate for their specialty, if they delivered service at an in-network hospital”.  Get it?  This is the insanity we accept.  It is like an Abbott and Costello routine.  What if your not an ancillary provider but a regular provider doing out-of-network work at in-network rates?  I guess that would be acceptable as long as you didn’t tell anyone.  But an out-of-network hospital always can be billed at an out-of-network rate unless the provider was ancillary and in-network, which results in canceling each other out.  I don’t know.  Third base.

We need to STOP the madness and get rid of this mess.  This is a game created by insurers and we all have now accepted it as dogma.  It’s an illusion that doesn’t have to be.

 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “More Games to Play

  1. Rich
    June 11, 2015 at 2:50 pm

    It’s long overdue. Their charges ought be bundled into the DRG for commercial payers as well. Does it make sense for a pathologist to make a “professional” fee on every lab test spit out by a machine? If it’s professional oversight, the hospital should pay them a stipend. Crazy.

  2. Ben Van Raalte
    June 9, 2015 at 1:38 pm

    This is NOT a bad thing. The problem is specialists like anesthesiologists get an exclusive contract for the hospital. Then they refuse to sign the insurance contract that already contracted with the hospital. Then they balance bill the patient for large charges. Over the years this has led to inflation of the reimbursement for anesthesia compared to surgery. Patients choose their surgeons if they are in the plan leading to deflation of fees. They do not get to chose their anesthesia.
    It is as if you built a house. You hired a contractor. The contractor hired subcontractors. Despite you agreeing to pay 300,000 for the house you get another 200,000 in bills from the subcontractors because they say you dont have a contract with them.

    All doctors who have exclusive contracts with a hospital, radiology, anesthesia, ER, should be required to automatically be in the plans the hospital signs. Note these are all the highest reimbursed specialties for the hours worked, which reflects decades of billing around the system with no feedback or cost control.

    • Doug Farrago
      June 9, 2015 at 2:09 pm

      I agree with you. The gouging by these docs is ridiculous. I guess my point was how crazy are the games we have to play to keep this crap under control and we have to let the insurers determine the rules.

    • Pat
      June 9, 2015 at 3:22 pm

      Those are good points, but I’d bet the farm that handling this through legislation will cause far more problems than it solves.

    • Rswatkins
      June 9, 2015 at 4:17 pm

      “Despite you agreeing to pay 300,000 for the house you get another 200,000 in bills from the subcontractors because they say you dont have a contract with them.”

      So the contractor has it in his agreement with the subs that what he pays constitutes payment in full.

      It should be handled between the hospital and the docs. This new law gives ALL the negotiating power to the insurers: “Our new contractual fee state-wide for reading a chest CT is $2. Don’t like it? OK, don’t sign the contract, but that’s still all you’ll get.”

  3. RWatkins
    June 9, 2015 at 12:06 pm

    So this will allow insurers to set their in-network rates so low that no hospital-based docs will contract with them, but they’ll still be forced to accept those fees as payment in full.

    I guess the 13th amendment no longer holds.

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