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[WedgeX]

Early last year, executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room. The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare was something hundreds of other hospitals across the country had done.

That’s when the trouble began.

Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code.

On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649.

“The billing scenario, that was the real fiasco and caught us off guard,” said Tom Wilbur, the chief executive of Newport Hospital. “Hindsight being 20/20, we never would have done that.” Faced with angry patients, the hospital took back control of its coding and billing.

Newport’s experience with EmCare, now one of the nation’s largest physician-staffing companies for emergency rooms, is part of a pattern. A study released Monday by researchers at Yale found that the rate of out-of-network doctor’s bills for customers of one large insurer jumped when EmCare entered a hospital. The rates of tests ordered and patients admitted from the E.R. into a hospital also rose, though not as much. The use of the highest billing code increased.

Courtesy the NY Times.

Causing problems even among the insured.

 

[uncelestial]

Gouging the most vulnerable people in the world who are literally in life or death situations. Classy.

 

[Piecake]

Wow, and I thought Insurance networks were awful before I read this.

 

[Jakoo]

As someone that has worked on the ACA exchanges and worked with health insurance companies, I think this is an often undiscussed reason for the rising cost of care in the country.

As per the example in this story, if you go into a hospital that is in network, the assumption is that all of the costs would be billed at in-network rates. This isn't always the case though--sometimes an individual person who takes blood work might not be in network even though the hospital is, which raises the cost of care. This can lead to tons of hours on the phone with health insurance folks, which is a huge time suck that is difficult while you are simultaneously getting critical treatment.

Because there are so many middle men involved with health care/insurance (employers, health insurance carriers, different medical providers, and state/federal govts), there is a lack of price transparency where you really have no idea what you are paying for until you actually get it, especially in emergency situations. As a result, there is no easy way for health consumers to actually shop on the basis of prices.

When people cannot shop around on the basis of price, this allows providers (and the producers of medical equipment/supplies to those providers) to charge whatever they wish, even if it's above it's actual value. Couple this with the fact often times providers will inflate prices to compensate for the fact that many times they cannot collect from some lower-income patients, the margins do not bode well for folks that are on the hook for those bills.

Medical providers should be on the hook for quoting a treatment from the jump and sticking to that value, and if they overshoot that quote, they bear the cost. I think the overall cost of care would go down compared to now where the true cost of care is disguised and obfuscated by a cluster fuck of middle men.

 

[Funyarinpa]

Lowkey thought NYT was exploiting healthcare for a sec

 

[bachikarn]

Because there are so many middle men involved with health care/insurance (employers, health insurance carriers, different medical providers, and state/federal govts), there is a lack of price transparency where you really have no idea what you are paying for until you actually get it, especially in emergency situations. As a result, there is no easy way for health consumers to actually shop on the basis of prices

This is what annoys me a lot. The doctors don't discuss payment whatsoever. If you don't ask, you basically have no idea until you get the bill. Ridiculous.

 

[MightyKAC]

On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. For a patient needing care with the highest-level billing code, the hospital's previous physicians had been charging $467; EmCare's charged $1,649.

The Free Market ladies and gentlemen, always looking out for the little guy

Spoiler

s wallet

.

 

[Foffy]

Vile fuckin' worms.

 

[G.ZZZ]

Free market baby.

 

[FreedomFighter]

American SICKcare is a massive racket.