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Tag: Surprise medical bill

  • Unless you have Medicare, surprise ambulance bills are common

    Unless you have Medicare, surprise ambulance bills are common

    Unless you have Medicare, surprise ambulance bills continue to be a serious concern for most Americans, even Americans with health insurance. Often the local ambulance is out of network and comes with a high price tag. If you have Medicare (or Medicaid), thankfully, you should never see a surprise bill of any type.

    Federal law protects people with Medicare and Medicaid against all surprise medical bills. But, no federal law protects anyone else from these bills. The recent federal law that protects working people from surprise bills does not include bills from ground ambulance companies.

    People needing ambulance services are at grave financial risk. More than eight in ten ground ambulance rides are not in network. At the moment, Congress is not addressing surprise ambulance bills. Rather it has established an ambulance advisory committee, which has yet to meet, as Bob Herman explains in Stat News.

    Some suggest that the ambulance rates should be based on Medicare’s rate of around $500. But, ambulance companies argue that rate is too low. Until Congress acts, Congress is subjecting people to unreasonable health care costs and putting them at risk. You cannot easily shop around for ambulance services.

    What can you do to protect yourself against a surprise ambulance bill? The best you can do is find out from your health plan the names and phone numbers of the ambulance services in your network and post that on your fridge. If you need an ambulance and it’s not a dire emergency, you will know who to call.

    Who owns the ambulance companies? Mostly municipalities and local fire departments.  About ten percent of the time, private equity or a Wall Street firm owns the ambulance companies.  Congress did not want to mess with their revenue streams.

    Ten states protect their residents from surprise ambulance bills.  The state laws are limited and protect people only if they have state-regulated insurance. The 100 million people who work for a company that self-insures have no protection against surprise bills. Their insurers will pay something, but the patient is left paying the difference, which was more than $2,000 in one municipality, where the fire department offers ambulance services.

    What can you do if you get a surprise ambulance bill?  You can appeal the ambulance charge, ideally with the help of your Human Resources department. But, the arbitration process in place to settle disputes is protracted and unworkable. 

    Here’s more from Just Care:

  • When will Congress address surprise ambulance bills?

    When will Congress address surprise ambulance bills?

    Surprise medical bills are all too common, leaving millions of Americans with health care costs they did not expect to pay. A couple of years ago, Congress passed legislation to end surprise medical bills for some services, but the ambulance industry was able to keep Congress from protecting Americans from surprise ambulance bills. Fortunately, people with Medicare have protections and generally do not have to worry.

    Congress was resistant to addressing surprise ambulance bills allegedly in deference to municipalities that generate substantial revenue from running ambulance services. Congress also claimed not to have a good handle on the appropriate cost of ambulance services.

    A new report from US PIRG describes the toll that surprise medical bills takes on Americans needing ambulance services. Even in the 10 states that go farther than federal law to protect their insured residents from surprise ambulance bills, anyone working for a large employer with a self-funded ERISA health plan—a very large cohort—does not have protection from their state laws.

    The problem of surprise ambulance bills needs addressing for multiple reasons. For one, we are talking about a large cohort of the population. Some three million Americans with private insurance use ambulance services each year. Who knows how many do not seek critical care for fear of the cost, endangering themselves.

    Second, when people call 911, they have no control over whether the ambulance that comes for them is in their health care provider network. About half the time the ambulances are out of network. Every ambulance affiliated with 911 should be in the insurers’ networks.

    Today, working Americans with health insurance are scared to call 911 in an emergency, for fear of an ambulance arriving that is out of network and receiving a surprise bill that they cannot afford to pay or do not want to add to their list of expenses. The typical out-of-pocket cost is $450, but in some states it is more than $1,000. Millions of Americans at risk.

    What you can do: Talk to your members of Congress about the urgent need to end surprise ambulance bills. In the meantime, find out which ambulance services are in your health plan’s network, and put their numbers in your phone contact list and/or on a list of important contacts in your home. Share it with your loved ones and  health care proxy.

    Here’s more from Just Care:

  • New government rules to protect patients from surprise medical bills face pushback from doctors

    New government rules to protect patients from surprise medical bills face pushback from doctors

    New rules issued by the US Department of Health and Human Services (HHS) that protect patients from surprise bills face pushback from doctors and scores of members of Congress. Secretary of HHS, Xavier Becerra, says that the goal is to keep physicians and hospitals from charging prices that are significantly higher than the average market price. Most important, patients will no longer have to deal with these unexpected bills.

    The rules are the Biden administration’s attempt to make good on Congress’s No Surprises Act. The Act is intended to protect patients with private health insurance from unexpected bills sent to them from out-of-network providers, excluding ambulance companies. Instead of burdening patients with these bills, doctors and hospitals are required to negotiate their rates with insurers. If that doesn’t work, they must go to arbitration.

    The HHS rules appropriately assume that a fair rate is around the average that health insurers are paying for similar services. Some doctors groups are suggesting that they might be driven out of business if their rates are forced down to an average rate. But, HHS feels that the primary goal needs to be protecting patients. Moreover, HHS does not believe it will hurt physicians who are charging well over the average rate to accept an average rate.

    No patient should be forced to pay two or three times more than the average cost. A recent HHS report on surprise medical bills reveals that out-of-network charges average $1,219 for anesthesiologists and $24,000 for air ambulances.

    The HHS rules are projected to bring down health insurance premiums by as much as one percent, according to the Congressional Budget Office.

    One hundred and fifty-two Republican and Democratic members of Congress are not happy with the HHS rules and would like to see them revised. They argue that the rules give too much power to the insurers but don’t seem to consider the fact that many physicians and hospitals are using their power to gouge patients and send them into medical debt.

    Here’s more from Just Care:

  • Beginning January 2022, HHS bans surprise bills from out-of-network providers

    Beginning January 2022, HHS bans surprise bills from out-of-network providers

    HHS has issued an interim final rule that bans surprise bills for patients who receive care from out-of-network providers at in-network hospitals. The rule applies to both emergency and non-emergency care, reports Joyce Frieden at Medpage Today.

    Many patients find, even when they are careful to see in-network doctors at in-network hospitals, that they receive care from a range of 0ut-of-network providers as well. Radiologists, anesthesiologists and emergency doctors are three types of specialists that often do not provide in-network care. With this new HHS rule, patients will only pay the in-network copay for out-of-network services in in-network hospitals.

    The HHS rule builds on Trump administration policy. It bans surprise medical bills as well as high charges from out-of-network providers for non-emergency care for which people have no advance notice. These are unexpected charges because they are either buried in the fine print from an insurer or are left out.

    People who receive out-of-network services in non-emergency situations need to have notice and give their consent. As it is, when patients are billed for out-of-network care, their out-of-pocket payments generally do not count towards their deductible or their out-of-pocket cap.

    The HHS interim final rule also forbids insurance companies from retroactively denying emergency room visits, reports Robert King for Fierce Healthcare. In essence, insurers cannot second guess individuals as to whether they experienced an emergency after they receive emergency services. Insurers must pay these claims.

    HHS plans to issue a series of other interim final rules in the next several months. It will be requiring better price transparency for consumers as well as better tools for comparing provider charges. HHS Secretary Xavier Becerra wants these rules to be crystal clear and understood by all parties so that they actually work in practice and not simply in theory. Time will tell.

  • Why Congress isn’t stopping ambulances from issuing surprise bills?

    Why Congress isn’t stopping ambulances from issuing surprise bills?

    The new federal law banning surprise medical bills does not do as good a job protecting people from unexpected bills as traditional Medicare–which does not allow them at all. It simply keeps out-of-network doctors, hospitals and air ambulances from charging patients directly for services they receive, over which they have little if any control. But, it doesn’t stop out-of-network ground ambulances from charging people a small fortune for their services. Why doesn’t it?

    Of all the surprise bills people receive, ambulance bills are particularly common. By some accounts, more than seven in ten ambulance rides are out of network. And, the average cost to patients for the service is $450. But, even though these costs keep people from calling 911 in a health emergency, members of Congress could not bring themselves to ban out-of-network bills for ambulance services.

    Part of the issue, according to the New York Times, is that federal lawmakers did not want to take on local lawmakers who are often responsible for allowing these ambulance bills. Many ground ambulances are run by municipalities that need the money they receive for out-of-network services, particularly given the economic devastation Covid has wrought.

    High private ambulance charges are common. But, public agencies that provide ambulance services appear to be as bad as private ambulance companies at sending out surprise bills. In a given year, patients owe around $129 million for ambulance services.

    Members of Congress also apparently felt that they did not know enough to regulate ambulance companies. For example, there is little information on what it costs to maintain an ambulance. They did not want to act rashly, perhaps thinking that they would drive ambulance companies out of business.

    Many states that are regulating surprise bills do not yet regulate ambulance services. Shockingly, in Texas, 85 percent of ambulance services are out of network. City-run ambulances do not have contracts with health insurers. In Colorado, private ambulances cannot issue surprise bills; but, they can charge as much as 3.25 times Medicare’s rate for ambulance services. Public ambulances can send out surprise bills, allegedly because the fire chiefs who often provide ambulance services lobbied against having the fire departments’ bills regulated.

    Instead of banning surprise ambulance bills, Congress established a commission to examine and report back information about ground ambulance services and bills. Traditional Medicare pays a regulated rate for ambulance services. It plans to collect more data on ambulance costs and share it.

    Here’s more from Just Care:

  • New law prevents doctors and hospitals from sending patients surprise medical bills

    New law prevents doctors and hospitals from sending patients surprise medical bills

    People with traditional Medicare never receive surprise medical bills because doctors are not allowed to bill them directly for services they receive, except in the rare instances in which they have agreed in writing to be billed. But, nothing prevents doctors from billing people with private insurance coverage for their services, until now. Congress just passed a law forbidding out-of-network doctors from billing patients with insurance for their services.

    So, what if you receive care at an in-network hospital and a group of out-of-network doctors treats you? The new law, which is part of the latest Congressional COVID relief bill, requires doctors and hospitals to duke out billing issues with insurers directly and prohibits them from billing patients, even when these providers are out of network. It is illegal for doctors and hospitals to bill you for out-of-network services.

    The new law should help millions of Americans, as about one in five Americans end up receiving surprise bills today. The average surprise bill for people who visit the hospital emergency room is more than $600. In some cases, patients have gotten bills for more than $100,000.

    Some corporations who own medical practices have made a fortune off of surprise bills. They buy up medical practices, have the doctors go out of network, and charge enormous fees for their services.

    Fortunately, Republicans and Democrats in Congress agree that this practice must stop, as do the overwhelming majority of their constituents. Already many states do not allow surprise medical billing. It is about time that Congress stepped in on behalf of every American, even though some doctors and hospitals are not happy about losing revenue.

    What’s totally insane about the Congressional legislation? It doesn’t take effect for another year, and it excludes ground ambulance services. It does cover air ambulances.

    So, watch out. If you end up in a network hospital in 2021, tell the hospital that you only want to be seen by doctors in your insurer’s network. It could help you from receiving surprise bills.

    Beginning in 2022, if doctors and insurers can’t agree on a rate for out-of-network services, they can take the issue to arbitration. The arbitrator will base a decision on the typical commercial rate for the services.

    Here’s more from Just Care:
  • Private equity succeeding at keeping Congress from ending surprise medical bills

    Private equity succeeding at keeping Congress from ending surprise medical bills

    People with Medicare are among the only Americans with health insurance who are spared surprise medical bills. Everyone else lives in fear of going to an in-network hospital and not being able to ensure that the doctors who treat them are also in-network. To date, private equity firms that own doctors’ groups are succeeding at keeping Congress from ending these surprise medical bills.

    It’s hard to understand why these moneyed interests have been able to get away with charging enormous sums for care they provide. But, then it’s hard to understand why hospitals and pharmaceutical companies have been able to get away with charging astronomical rates. 

    The overwhelming majority of Americans want Congress to make health care affordable. It’s a top priority for Republicans and Democrats alike. As it is, one in four Americans say that they skip or delay care because of the cost, even when they have insurance. One in six received a surprise medical bill in 2017. 

    The power behind surprise medical bills comes from investors in private equity and venture capital firms, according to Kaiser Health News. Particularly in the areas of anesthesia and emergency medicine, investors now own large physician groups. To maximize their profits, they stay out of health insurance networks. And, they charge patients very high prices.

    Instead of working for hospitals, these doctors’ groups work for companies owned by hedge funds. And, hospitals contract with these companies for their services, sometimes getting a share of the profits the companies earn. Members of Congress fear taking down these companies. If they act, they are likely to jeopardize their reelection, with these investor-owned companies supporting their opponents.

    The two biggest companies that own doctors’ groups are TeamHealth and EmCare, which are owned by Blackstone and KKR respectively, two large private equity firms. They are doing particularly well since, in most states, they have no reason to provide in-network services. They can stay out of network and charge patients with private insurance pretty much what they will on top of what the insurer pays.

    The only solution that will rein in health care costs and protect Americans is for the federal government to step in and regulate all provider rates. That is not on the table in Congress. The best solution on the table–proposed by employers and insurers–would have insurers pay out-of-network physicians the average of the rate in-network physicians are paid. That rate is already far higher than Medicare rates.

    But, the employers and insurers are being outspent by the private equity firms. Private equity is arguing for arbitration. New York has a state law that settles surprise billing disputes through arbitration and it has served the private equity firms well. Costs have gone up. Because private equity firms have deep pockets, so far, they are winning.

    Here’s more from Just Care:

  • Will we see an end to surprise medical bills?

    Will we see an end to surprise medical bills?

    Doctors and other health care providers are billing unsuspecting patients ever increasing amounts for out-of-network care. A new report from the Health Care Cost Institute reveals which doctors and other health care providers are more likely to charge insured patients for out-of-network care, sending out “surprise medical bills.” Congress agrees surprise medical billing is a problem, but it can’t seem to agree on how to address it.

    In many cases, surprise medical bills are for thousands of dollars, and patients have no control over them. Too often, patients end up in medical debt. Fortunately, it is less of a problem for people with Medicare because providers are limited in what they can charge people with Medicare.

    Pathologists, specialists who study tissues and fluids to help diagnose medical conditions, are the health care providers who most frequently bill for out-of-network care. More than one in three pathologists billed hospitalized patients for out-of-network care more than 90 percent of the time. And about one in five pathologists billed patients for outpatient visits out-of-network more than 90 percent of the time.

    Much like pathologists, a large share of emergency care providers bill patients for out-of-network inpatient care. About 44 percent of providers in both specialties. Emergency care doctors do not send out surprise medical bills as frequently as pathologists. But, when they do bill for out-of-network care, the charges can be sky-high.

    Members of Congress on both sides of the aisle support legislation to address surprise medical bills. But, they have not been able to reach agreement on a solution. The simplest solution would be for the government to limit what health care providers can charge for their services out of network. But, hospitals and private-equity firms, which sometimes own pathology and emergency care medicine practices, are arguing for arbitration.

    Recent Congressional legislation appropriating stimulus money for hospitals in response to the coronavirus pandemic specifically forbids hospitals from sending surprise bills to patients receiving COVID-19 care. Still, stories abound of patients receiving surprise bills for COVID-19 care, including one person in Denver who received a bill for $140,000.

    HCCI researchers found that in addition to pathologists and emergency medicine providers, many other types of specialists bill patients for out-of-network care, though at different frequencies. The proportion of providers with at least one out-of-network claim for inpatient visits ran the gamut from 18% for cardiology to 44% for emergency medicine. For outpatient visits, the share of providers with at least one out-of-network claim ranged from 15% for behavioral health to 49% for emergency medicine.

    Here’s more from Just Care: