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