Balance Billing: Time for Docs to Participate
Balance billing, the surprise fees by out-of-network providers that make having a real number of what your medical bills will be impossible should be where we put our sights with the repeal of Obamacare. Obamacare did little to protect consumers from this predatory provider conduct, choosing instead to offer the grandiose provision that consumers can use any emergency room but leaving consumers hanging for every other service they receive.
Instead, we're supposed to be clutching our list of "participating providers," and in that emergency room be able to distinguish between who can give us a particular needed medical service or face the unfettered charges of predatory providers getting rich off the backs of desperate patients. And make no mistake, that's what balance billing is. (http://kff.org/private-insurance/issue-brief/surprise-medical-bills/)
It's time for providers, including physicians to participate in solutions for a healthcare crisis.
Today, more and more physicians choose to be employees of hospitals over private practice, (search private practice physicians drop). This is an opportunity for a consumer rescue from balance billing, but because Obamacare focused on saving payers money (insurers and government) with an insurance-government partnership and because of the strength of the lobbies of the insurance industry and physicians, only one group got squeezed under Obamacare--consumers.
It is suggested here that instead of worrying about repeal and replace, translated into more of the same, consumers begin using our new-found knowledge of health insurance to obtain meaningful change and this begins with the providers, specifically physicians.
You need go no further than the American Medical Association's brutal greedy policy expressed by its President Dr. Steven Stack, who said in June of 2014, “Putting in a methodology to coerce physicians through yet another way to not receive sufficient payment doesn't help patients and certainly is not fair to physicians,” he said. “Insurance regulators would do well to focus on the behaviors of the insurance industry first," http://www.modernhealthcare.com/article/20150614/blog/150619956. Get it? Requiring physicians to participate in at least two health insurance plans in their region is "coercion" and if anyone tries to create such a requirement then that "doesn't help patients," which to me is a thinly veiled threat of denial of care or worse yet substandard care.
This is where balance billing must be addressed by state medical licensing boards, which could make participation in at least two regional health insurance plans by every provider doing business within its borders could but haven't done anything for the most part.
This is where balance billing could be addressed by insurers who instead happily contenting themselves with ignoring the financial jeopardy of their insureds as they charge more and cover less with overly narrow networks and larger copays, coinsurance, deductibles and premiums could focus on making sure that INSURANCE coverage, the cost of unexpected needed medical services are adequately covered with sufficient numbers of specialists and services to render insurance policies, consumer financial products, attractive to consumers instead of partnering with government to force us all to purchase their products.
This is where state representatives could work in their state insurance departments and licensing boards to prohibit balance billing in hospitals.
This is where the federal government could use its information-gathering and FINE providers and organizations that bill in excess of a certain percentage in the form of balance billing each year.
This is where hospitals could require that privileges to work within their walls requires that every service be a participant in at least two regional insurance plans.
This is where providers could influence their own reimbursement by participating in insurance plans that provide better guaranteed payment to them for their services.
It starts with the acknowledgment that ANY healthcare industry reform REQUIRES that the sticks used on the American people under Obamacare be used ON BEHALF of the American people.
Obamacare brought us a sustainable WELLNESS healthcare industry off the backs of taxpayers with its hyperfocus on the cheap and finite checkups which saves the government and insurance company payers money--While convenient, this industry of treating the well was neither the cause of our original healthcare crisis nor is it the solution. The coverage of FINITE costs, checkups and such is a perk not a replacement for coverage of the UNEXPECTED AND UNANTICIPATED costs of paying for the services of a whatever the market will bear pool of providers.
Originally these WELLNESS checkups and programs were part of an insurance company strategy to save themselves costs, now it's a hammer used to force patients to run through a gamut of checkups which supports a wellness healthcare system that often leaves patients unable to have access to and afford care if one of those checkups indicates NEEDED medical care and services.
There should be consumer backlash when the physician lobby whines that doctors should not be limited in what they can charge threatening that level of care (it's not fair to the patient) would suffer if they were held to a requirement that their physicians belong to at least one or two of the regional plans most used where they practice.
There should be consumer backlash when both state and federal government ignore the physician bully pulpit as they instead choose to hammer the weakest group, consumers, with rules to save themselves money as payers rather than flex their strength and authority over the practice of medicine in their regions.
There should be consumer backlash against defensive medicine.
We are the ultimate payers, whether it's through tax dollars, fees, insurance premiums it is the consumer who finances the healthcare industry.
Instead, we're supposed to be clutching our list of "participating providers," and in that emergency room be able to distinguish between who can give us a particular needed medical service or face the unfettered charges of predatory providers getting rich off the backs of desperate patients. And make no mistake, that's what balance billing is. (http://kff.org/private-insurance/issue-brief/surprise-medical-bills/)
It's time for providers, including physicians to participate in solutions for a healthcare crisis.
Today, more and more physicians choose to be employees of hospitals over private practice, (search private practice physicians drop). This is an opportunity for a consumer rescue from balance billing, but because Obamacare focused on saving payers money (insurers and government) with an insurance-government partnership and because of the strength of the lobbies of the insurance industry and physicians, only one group got squeezed under Obamacare--consumers.
It is suggested here that instead of worrying about repeal and replace, translated into more of the same, consumers begin using our new-found knowledge of health insurance to obtain meaningful change and this begins with the providers, specifically physicians.
You need go no further than the American Medical Association's brutal greedy policy expressed by its President Dr. Steven Stack, who said in June of 2014, “Putting in a methodology to coerce physicians through yet another way to not receive sufficient payment doesn't help patients and certainly is not fair to physicians,” he said. “Insurance regulators would do well to focus on the behaviors of the insurance industry first," http://www.modernhealthcare.com/article/20150614/blog/150619956. Get it? Requiring physicians to participate in at least two health insurance plans in their region is "coercion" and if anyone tries to create such a requirement then that "doesn't help patients," which to me is a thinly veiled threat of denial of care or worse yet substandard care.
This is where balance billing must be addressed by state medical licensing boards, which could make participation in at least two regional health insurance plans by every provider doing business within its borders could but haven't done anything for the most part.
This is where balance billing could be addressed by insurers who instead happily contenting themselves with ignoring the financial jeopardy of their insureds as they charge more and cover less with overly narrow networks and larger copays, coinsurance, deductibles and premiums could focus on making sure that INSURANCE coverage, the cost of unexpected needed medical services are adequately covered with sufficient numbers of specialists and services to render insurance policies, consumer financial products, attractive to consumers instead of partnering with government to force us all to purchase their products.
This is where state representatives could work in their state insurance departments and licensing boards to prohibit balance billing in hospitals.
This is where the federal government could use its information-gathering and FINE providers and organizations that bill in excess of a certain percentage in the form of balance billing each year.
This is where hospitals could require that privileges to work within their walls requires that every service be a participant in at least two regional insurance plans.
This is where providers could influence their own reimbursement by participating in insurance plans that provide better guaranteed payment to them for their services.
It starts with the acknowledgment that ANY healthcare industry reform REQUIRES that the sticks used on the American people under Obamacare be used ON BEHALF of the American people.
Obamacare brought us a sustainable WELLNESS healthcare industry off the backs of taxpayers with its hyperfocus on the cheap and finite checkups which saves the government and insurance company payers money--While convenient, this industry of treating the well was neither the cause of our original healthcare crisis nor is it the solution. The coverage of FINITE costs, checkups and such is a perk not a replacement for coverage of the UNEXPECTED AND UNANTICIPATED costs of paying for the services of a whatever the market will bear pool of providers.
Originally these WELLNESS checkups and programs were part of an insurance company strategy to save themselves costs, now it's a hammer used to force patients to run through a gamut of checkups which supports a wellness healthcare system that often leaves patients unable to have access to and afford care if one of those checkups indicates NEEDED medical care and services.
There should be consumer backlash when the physician lobby whines that doctors should not be limited in what they can charge threatening that level of care (it's not fair to the patient) would suffer if they were held to a requirement that their physicians belong to at least one or two of the regional plans most used where they practice.
There should be consumer backlash when both state and federal government ignore the physician bully pulpit as they instead choose to hammer the weakest group, consumers, with rules to save themselves money as payers rather than flex their strength and authority over the practice of medicine in their regions.
There should be consumer backlash against defensive medicine.
We are the ultimate payers, whether it's through tax dollars, fees, insurance premiums it is the consumer who finances the healthcare industry.
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