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You are here: Home / Anderson On Health Insurance / Network information

Network information

by David Anderson|  November 30, 20169:01 am| 76 Comments

This post is in: Anderson On Health Insurance, World's Best Healthcare (If You Can Afford It), Bring On The Meteor

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You know what's messed up, that I had to call the hospital to make sure the anesthesiologist would be in network for my daughter's birth.

— Loren Adler (@LorenAdler) November 28, 2016

What normal person not entrenched in this issue would think to do that naturally, when you know the hospital is in network?? https://t.co/fnp7M40UyF

— Loren Adler (@LorenAdler) November 28, 2016

Loren is a healthcare wonk. He knows this shit cold and he is right, no one in their right mind would think to call the in-network hospital to see if the anesthesiologist would be in-network if a laboring mother to be needed/wanted an epidural.

As other wonks in the tweet stream noted, the best that he could hope for is the hospital to give him a non-binding informational advisory that their anesthesiologists were or were not in network. And even here, the information is incomplete. Many carriers will offer a number of different networks in the employer and individual markets. Some carriers will tell providers that they are in seven of the twelve networks offered. In those cases, the office manager or the billing clerk might be able to tell an interested patient who is trying to effectively shop for planned care whether or not Dr. Smith is in-network for them. Here the system may not be working but it is not flailing around completely in a fireball of fail.

However not all carriers will do this. Instead they’ll send Dr. Smith seven contract amendments for the seven current networks that they want Dr. Smith in. They will never send him the other five narrow network amendments to sign or reject. So when a patient is trying to conform to the system that we impose on them, the billing manager will honestly say “Yep, we take all plans from Mayhew Insurance….” and three months later as the claim is submitted and everyone expects an in-network charge, the patient gets whacked with an out of network bill.

Our provider information systems are designed to fail in a Kafka-Goldberg-Dilbert menage a trois.

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Reader Interactions

76Comments

  1. 1.

    Kathleen

    November 30, 2016 at 9:10 am

    Good Morning All! A former coworker who had been customer service rep for xxx told me about tht several years ago.

  2. 2.

    raven

    November 30, 2016 at 9:11 am

    I started the day with this comment: “Well, BCBS denied our visit to urgent care and the subsequent trip to the orthopedic clinic when my wife broke her wrist. The documentation I read says they will pay for emergency situations so I’m hoping an appeal will help. It’s a couple of thousand dollars and I shudder to think what would have happened had we not been told that they would not pay for the surgery in Florida. I also didn’t realize ACA had expanded appeal rights. I better get on it!”

    I called them and finally got a person. I think it was the same woman who told me that they would not cover the surgery in Florida. She was very nice and said, because it was an injury and an emergency she was pretty sure she could get the denials reversed.

    When we did have the surgery there was a sign in the office saying the anesthesiologist might not be in the network!

  3. 3.

    J.

    November 30, 2016 at 9:16 am

    Our health care system — make that medical insurance business — is fucked up. Remind me again why single payer with fixed pricing is a bad idea?

  4. 4.

    germy

    November 30, 2016 at 9:21 am

    @J.: I remember one commenter worrying about all the insurance company employees losing their jobs.

  5. 5.

    MrSnrub

    November 30, 2016 at 9:27 am

    When my wife was undergoing treatment for Thyroid cancer (completed successfully), the endocrinologist prescribed a specific medication as part of the treatment. It was a pair of injections designed to force remaining thyroid cells into overdrive, making them easier to detect.

    As a prescription benefit, the cost was $1600. My wife works in insurance and told the doctor’s office to resubmit as a medical benefit. Resulting cost to us: $100. I would have had no idea that there was a separate way to pay for this, and considering that the doctor’s office submitted the claim, I wonder how many patients wound up paying the $1600 cost.

    And I’ll be that they still are.

  6. 6.

    Mineshaft Gap

    November 30, 2016 at 9:31 am

    This exact situation happened during my wife’s hysterectomy a few years ago. How am I supposed to know ahead of time that one of the physicians in the operating room is not in network, when her doctor performing the operation and the hospital are in network? Ridiculous system we have here.

  7. 7.

    MomSense

    November 30, 2016 at 9:40 am

    Same thing happened to me when I had knee surgery. Again, the whole idea of being a shopper of health services is completely bogus since it is nearly impossible to get pricing information and difficult to figure out in advance what is covered and what isn’t. The idea that the anesthesiology required for your medical procedure wouldn’t be covered is counter intuitive. Most people do not think to check on this.

  8. 8.

    Socratic Me

    November 30, 2016 at 9:42 am

    ‘One of the doctors might not be on network.’ How quaint. Our regional hospital (which doesn’t call itself that now that it has been consumed by a horrid management company) is the only one within an hour drive of here. It is listed as in network for pretty much every company insurance plan in the area, as they are the only hospital service provider, so not including them would make the plans pretty much useless. As best as my wife and I can figure after several trips to the hospital, none of their doctors are on network. They all bill under a seperate entity that charges huge costs and bills them as out-of-network.

    This means, among other things, that we regularly ask ourselves if we can afford to drive an hour or just avoid the hospital altogether, even when we really shouldn’t, because we know we will inevitably get nailed for costs we can’t anticipate or afford.

  9. 9.

    Cermet

    November 30, 2016 at 9:58 am

    @MomSense: All of this isn’t a bug in the software but rather what makes it work – bankrupt the lower classes; this is identical to business law and similar types of laws in the tax system where the average person is hopelessly out class and only the money elite can game the system making sure the rubes pay through the nose and are kept in semi-slavery to their jobs through health care.

    Glad some here succeed and aren’t getting screwed.

  10. 10.

    BigRed

    November 30, 2016 at 10:09 am

    First comment ever, since we had exactly this issue. After our second kid’s birth, we got a bill for an out-of-network anesthesiologist for the epidural. That was a surprise since the hospital was in-network. So, I called and complained. Nothing. Then I checked and noted the anesthesiologist was in the in-network directory (that was lucky, since of course we had no idea who would show up to do an epidural at 1 am). He wasn’t in-network, of course, the directory was wrong, so even if I had checked, I’d still have gotten the out-of-network bill. But they didn’t know I hadn’t checked before. So, more calls, finally I had to fax (it’s always fax, medical stuff is the only thing in the world that still requires faxes) over a printout of the network directory showing the guy was in-network on the directory. Finally, they covered it as in-network.

    BTW, first kid was at Kaiser-Permanente. Paid $200 at the end of the tour of the labor suite by credit card. Never saw another piece of paperwork about money.

  11. 11.

    MomSense

    November 30, 2016 at 10:09 am

    @Cermet:

    Feature not bug as we are fond of saying. I’m really at a loss about what will happen with the ACA and Medicaid expansion. Obviously the Republicans want to kill it but I would think the hospitals and providers would be lobbying to keep it since it has been really good for them. Then again, I thought that the providers would lobby LePage to expand Medicaid here in Maine and yet he managed to ignore them without consequence.

    Remember when Republicans argued that uncertainty was bad for business? Well this uncertainty has to be bad for business. I can’t be the only person who has decided to pinch all the pennies to try and save something for whatever ruin may befall us. That can’t be a good attitude going into the holiday shopping season. Anyone here know what the shopping numbers are like so far?

  12. 12.

    sam

    November 30, 2016 at 10:10 am

    Here’s a wacky one – last year I went for my “routine physical”. This is one of those things that, under the ACA is supposed to be a completely “no cost” item to me (even under my HDHP/HSA plan). I had to have them run some extra blood tests for another doctor (my endocrinologist), so I was expecting some sort of bill afterwards for that piece of things (which I got and paid without issue).

    What I was not expecting was to receive a separate bill for the TB test that my doctor administered in the middle of the physical. When I called to question the charges, they explained to me that the test was not included in a “routine physical”. The charges were pretty minor (less than $30), but I was still really annoyed on principle, because there was no point in time during the exam that anyone asked me whether I wanted this test, it was done as part of the series of things they do EVERY YEAR, and no one explained that there would be a separate charge.

    I could certainly afford this particular charge, but I can imagine there are others who might not be able to. Also, what if it had been a $300 charge?

    How the hell are we supposed to be good “consumers” if we don’t even know that we’re shopping?

  13. 13.

    liberal

    November 30, 2016 at 10:14 am

    @J.: Completely agree, but it’s not just a matter of the way insurance is structured.

    The fact is that many (most?) of these docs are not employees of the hospital.

    Can you imagine going to get your car fixed, and getting a bill from the garage, from the mechanic, from the guy who delivered the parts to the garage…?

    The fact is that the health care system is cray cray, not just the insurance system.

  14. 14.

    Scout211

    November 30, 2016 at 10:15 am

    California passed a bill this September to stop the out-of-network surprise billing. I think it goes into effect next July.

    ETA: AB 72

  15. 15.

    liberal

    November 30, 2016 at 10:15 am

    @sam: Yes, it’s completely nuts. There’s no way even a knowledgeable person can “shop for health care” or even put up with the kind of $hit you describe.

  16. 16.

    The Moar You Know

    November 30, 2016 at 10:19 am

    The “network” thing is a sick, sick joke. PPO you’d think would handle that. No. PPO is just another, expanded HMO and in a couple more years it won’t be an option for anyone, I’m betting.

    Had a couple of bouts of diverticulitis early this year. Hey, happy 50th! Anyhow, what with network shenanigans and whatnot, I tore through the out-of-pocket within a month.

    I was lucky, I had the money. Most people don’t.

    This isn’t working for anybody. A lot of people are panicking and think pulling up the ladder behind them is the only way they’re going to get any help at all.

  17. 17.

    Ruckus

    November 30, 2016 at 10:28 am

    @MomSense:

    I can’t be the only person who has decided to pinch all the pennies to try and save something for whatever ruin may befall us. That can’t be a good attitude going into the holiday shopping season.

    This is all we really have. Purchasing power. Not spending will of course ruin the economy and it’s rather difficult to not spend on medical issues without serious detriment to ourselves but it really is our power. I wonder if enough of us demanded to know all the insurance issues before we commit to a procedure how soon the wheels would come off the wagon?

  18. 18.

    Juice Box

    November 30, 2016 at 10:29 am

    @germy: That was probably me under my previous nym. There are a lot of people employed in insurance billing on both sides and some jobs pay quite well. It sucks an enormous amount of money out of the system, but eliminating it really would affect a lot of people. Medical billing specialists have cottage industry jobs and skills that don’t really translate to another field.

    IIRC, in 2010 the Robert Wood Johnson Foundation estimated that primary care doctors spend about $30B per year on insurance billing. Remember that primary care is only about a third of the physician workforce in the US.

    I had an appendectomy a few years ago, in January. In June, a collections agency called me and told me that I owed $306 plus collections fees for some reason. I paid it over the phone and put it aside to take to HR for an explanation. Before I got around to doing that, I received an unexpected $306 refund in the mail from BCBS, no explanation and not including the collection fees, of course. They let me go to collections for a bill they were going to pay. Eighteen months after the surgery I received a notice from BCBS that they were rescinding some payment for something from some doctor for some reason hidden in code. This was for one of the most straightforward surgeries possible.

  19. 19.

    Bodacious

    November 30, 2016 at 10:29 am

    First time unemployed (no tears for me) and on the ACA exchange. WAKE UP!!!! I can handle the expense (life is good), but am floored that if we travel 8 miles away from our house we no longer have coverage, except for the absolutely vague ‘live saving’ intervention. And even then, we would pay undefined rates because we are in the non-negotiated pool.
    Sounds like I’ve found a future purpose in life for a while…..health care activist. Any tips, Richard, how I can be most effective with my ‘spare’ time?

  20. 20.

    Betsy

    November 30, 2016 at 10:30 am

    With real problems like this proliferating everywhere, and causing interminable headaches if not financial disasters for more and more people,

    I really wonder why anyone sees fit to make a big issue of “the war on Christmas,” “overpaid teachers who work only part-time anyway,” “emails”

  21. 21.

    kindness

    November 30, 2016 at 10:32 am

    This actually happens. About 10 years ago one of the Kaisers in California’s Central Valley had a contracted hospital for their members in that area (it was a Sutter/Gould hospital). Well at one point the anesthesiologists & the ER physicians claimed they didn’t have a contract with Kaiser and wanted 100% of billed charges for the Kaiser members they saw. The Hospital fought on the side of the anesthesiologists and the ER physicians.

    Kaiser ended up building their own hospital in that area.

  22. 22.

    Betsy

    November 30, 2016 at 10:33 am

    … And sometimes it does make me wonder, the way that Bernie had of encapsulating an issue like this in few and cogent words, that maybe, just maybe, he could have talked the talk the way he did all the time, and people would have listened and more importantly heard their concerns being met head-on .. and he might have actually won the election …

    But I’m pretty darn sure that if he had been the nominee, I’d be ruing the loss of the Presidency and wondering why the hell we didn’t see fit to nominate the woman who was so obviously the most experienced, knowledgeable, hard-working presidential candidate in U.S. history ..

  23. 23.

    Betsy

    November 30, 2016 at 10:35 am

    @The Moar You Know: I am in that exact situation, in every way, right down to the 5-0. Thanks for sharing

  24. 24.

    germy

    November 30, 2016 at 10:41 am

    @Juice Box:

    There are a lot of people employed in insurance billing on both sides and some jobs pay quite well. It sucks an enormous amount of money out of the system, but eliminating it really would affect a lot of people. Medical billing specialists have cottage industry jobs and skills that don’t really translate to another field.

    Over the past forty years I had to retool my career(s) many, many, many times. Jobs I did in 1982 literally no longer exist. I had to retrain and do something new. Happened again in 1989, 1998, 2005.. etc. I don’t recall anyone worrying about my jobs disappearing.

  25. 25.

    Ohio Mom

    November 30, 2016 at 10:52 am

    If you take a step away and look at the entire healthcare industry as someone from another planet might, the only conclusion is that it is completely corrupt.

    That isn’t to say that the actual worker bees are corrupt, they aren’t in on the take at all. Some can be quite helpful to us marks (e.g., Richard Mathew).There are laws and patches that insulate us here and there from what could be a worse sting. But the industry itself is one giant shake down.

    I know, we don’t think of ourselves as a corrupt nation in the way we think of banana republics as corrupt, or those assorted dictatorships in Africa as corrupt. (Well, we haven’t up to this election…). But there it is.

  26. 26.

    beth

    November 30, 2016 at 11:05 am

    I’m about ready to explode over insurance. Spouse got a shot after first chemo treatment that we asked about and were told it was covered and pre-approved. He got the same shot after the next three chemo treatments – you can guess what happened next. Apparently they only cover one shot per chemo rotation and the shots are $10,000 each! Of course the hospital is giving us the “it’s ultimately our responsibility to make sure treatment is covered” bullshit. Hey theres a silver lining – they’re sure they can knock the cost down to $5,000 per shot! How are regular worried sick people supposed to stay on top of this?

  27. 27.

    Kilgore Trout

    November 30, 2016 at 11:11 am

    I agree this is crazy and I did the same thing before my colonoscopy last week. The gastroenterology group was in network but based on horror stories I’d heard I also made sure the specific doctor was in network.

  28. 28.

    germy

    November 30, 2016 at 11:13 am

    @beth:

    Apparently they only cover one shot per chemo rotation and the shots are $10,000 each! Of course the hospital is giving us the “it’s ultimately our responsibility to make sure treatment is covered” bullshit. Hey theres a silver lining – they’re sure they can knock the cost down to $5,000 per shot!

    Maybe this is why the donald won. Plenty of deplorables (not just us) had similar anecdotes about what we called the Affordable Care Act?

    Things were worse pre-ACA, but republican voters thought the GOP could do better. Except they won’t.

  29. 29.

    raven

    November 30, 2016 at 11:15 am

    @germy: “plenty” of vets bitch about the VA too. It doesn’t matter that the vast majority of vets get good service from the VA.

  30. 30.

    Enhanced Voting Techniques

    November 30, 2016 at 11:16 am

    @MomSense:

    Feature not bug as we are fond of saying. I’m really at a loss about what will happen with the ACA and Medicaid expansion. Obviously the Republicans want to kill it but I would think the hospitals and providers would be lobbying to keep it since it has been really good for them. Then again, I thought that the providers would lobby LePage to expand Medicaid here in Maine and yet he managed to ignore them without consequence.

    Well they talk like they are serious yet why are they talking at all if they are that serious? They are giving the opposition two months to get organized and they know it. It sounds like the GOP really want those damn hippies to save them from cutting their own throats on this. Maybe the right has drunk of the coolaid so deeply and off in fantasyland that the GOP figures their base would just blame the Democrats for anything bad that happens? Otherwise, assuming this is still a somewhat sane word this sounds more like the Republicans and stuck between their promise to do something destructive to the country and the consiquences of doing it, and are just going to screw Trump as a way out.

    Remember when Republicans argued that uncertainty was bad for business?

    That was before this Post Truth era.

  31. 31.

    Botsplainer

    November 30, 2016 at 11:19 am

    @beth:

    I’d just start killing people in the insurance chain. Since white people can open carry any place, any time, walking into the insurance office with rifles, bandolier loaded with extra mags, pistols and shotguns is your protected constimatooshinal right.

    What you do there is up to you, because until the moment you start shooting, you’re a good guy with a gun.

    Hint – find the suits at the C suite level first.

  32. 32.

    Calouste

    November 30, 2016 at 11:19 am

    @Juice Box: So if 1/3 of the US doctors spend about $30 Billion on medical billing a year, a total of $100 Billion seems to be in the ballpark. For $100 Billion you can pay 2 million people $50,000 per year just to sit on their arse and watch TV. Of course, you could also use part of that money to retrain them to do something else.

  33. 33.

    Mnemosyne

    November 30, 2016 at 11:19 am

    @Scout211:

    Yep, another reason it’s good to live in this solid blue state. There was a problem, people complained to their state representatives, and those representatives created a law to fix the problem. That’s how it’s supposed to work.

  34. 34.

    The Moar You Know

    November 30, 2016 at 11:19 am

    Plenty of deplorables had similar anecdotes about what we called the Affordable Care Act?

    @germy: They did and do. ACA has been for some a godsend, for a lot of folks nothing but utter frustration, and for some a complete disaster. Through good luck, I’m insured through my employer, so I fall into the “utter frustration” camp of my insurer (UHC) and the medical profession at large using the ACA as a license to loot and steal, both from me and from society.

    I don’t know what else could have been done that would have passed. Too many stupid people in this nation means single payer is never going to happen. Maybe we shouldn’t have done anything at all.

    ETA: I give up. Gonna get and stay focused on local races and calexit. This nation can’t be saved and I’m no longer willing to put in the effort to try.

  35. 35.

    Barbara

    November 30, 2016 at 11:21 am

    You should never assume that anesthesiologists, radiologists, pathologists or any other non-employee hospital based physician is in network. You have to ask. Anesthesiologists are the worst by far.

  36. 36.

    Gindy51

    November 30, 2016 at 11:22 am

    @MrSnrub: Same kind of thing for us, but it was our insurance company who told us to tell the hospital to resubmit under the proper code so they would pay it… Tricare is wonderful. It should be what everyone has.

  37. 37.

    germy

    November 30, 2016 at 11:23 am

    @raven:

    “plenty” of vets bitch about the VA too. It doesn’t matter that the vast majority of vets get good service from the VA.

    Did you see the CBS News report a few months ago? They did a whole story on privatizing the VA. The guy they took a stroll with and interviewed; I had to google him to learn he was fronting an organization pushing for privatization. CBS made it look like he was just a regular vet, looking for “common sense.”

  38. 38.

    Botsplainer

    November 30, 2016 at 11:23 am

    @MomSense:

    The advocacy will be ignored – no consequences have been delivered in 8 years except to Democrats for having the temerity to want to make some up front investments in healthcare and to try and even up the playing field economically.

    Forethought, caution, reasoned optimism and competence are no longer desirable business or governmental policies.

  39. 39.

    raven

    November 30, 2016 at 11:29 am

    @germy: CVA motherfucker, the only Vet rep to meet with meatball. Frankly I hope Vets do get fucked in this deal.

  40. 40.

    liberal

    November 30, 2016 at 11:30 am

    @raven: I don’t know if it’s still online, but there was a great article called “The Best Care Anywhere” about the VA.

    It makes a case (at least implicitly) that medicine should be socialized, not just insurance.

  41. 41.

    Another Scott

    November 30, 2016 at 11:31 am

    @Barbara: It may be fine to say that one has to ask, and that does indeed seem to be the case, but you have to know enough about what they plan to do to know who they plan to be there. Normal humans can’t know enough to even be able to ask the right questions.

    Kilgore Trout (above) mentioned a colonoscopy. I had my first one within the last year. I had little or no idea who would be there and what would be involved. I think about 6-8 people were in the room (I didn’t count). I had general anesthesia for the first time. How was someone in that situation to know who to ask at their insurance company about who would be covered when one doesn’t know who will be there?

    In my case, I wasn’t surprised with a huge bill, but I did end up paying a few hundred, I think (probably my annual deductible/whatever).

    It’s a broken system and needs to be fixed. But as long as it’s in the insurance companies’ interest to put as many roadblocks up as possible to avoid payment, this is going to be the situation we live in (and it’s likely to get worse under the Trump/Teabagger Administration).

    :-(

    Cheers,
    Scott.

  42. 42.

    gvg

    November 30, 2016 at 11:32 am

    @Ohio Mom: Healthcare is “corrupt” because they have the power of life and death. Its impossible for any human institution not to become corrupt when the power balance is that tilted. The founders knew this generally and tried to balance the created branches of government. They didn’t eliminate slavery though and even those who thought they were benevolent masters, had huge powers over their slaves and must have been feared more than they noticed. It corrupts the character to have that kind of power. Marriage used to be just as bad for women and I think it was bad morally for even the well intentioned husband. We have mostly fixed those problems but I don’t see any way to do that reform for doctors and insurance companies. This may be why some people got so hysterical about the “death panels”. the death panels already exist, called insurance, claims processing. The only thing I have thought of is explicitly pointing it out.

  43. 43.

    liberal

    November 30, 2016 at 11:34 am

    @Botsplainer: Quite frankly, I really don’t understand why this kind of thing doesn’t happen more often.

  44. 44.

    Enhanced Voting Techniques

    November 30, 2016 at 11:35 am

    @germy:

    Things were worse pre-ACA, but republican voters thought the GOP could do better. Except they won’t.

    The GOP has been admitting that this week that’s it’s almost impossible for them to come up with a REAL American(tm) replacement.

  45. 45.

    liberal

    November 30, 2016 at 11:35 am

    @Another Scott:

    But as long as it’s in the insurance companies’ interest …

    It’s NOT JUST THE INSURANCE COMPANIES. It’s the doctors, too. The AMA is one of the few really powerful unions left in the country, and not in a good way.

  46. 46.

    liberal

    November 30, 2016 at 11:38 am

    @The Moar You Know:

    Too many stupid people in this nation means single payer is never going to happen.

    Yes it will.

    As some point, both private insurance and private providers will become unaffordable due to multiple market failures and spiralling. At that point, it will all be socialized, like the NHS (which the Tories are slowly destroying).

  47. 47.

    Botsplainer

    November 30, 2016 at 11:47 am

    @liberal:

    When (not if) it happens, I’m unlikely to shed many tears.

    “He was a frequent participant in charity and church events and donated lavishly” isn’t going to cut it to whitewash the record of any exec who sheds this mortal coil via the physics of the bullet.

    Not for me, anyway.

  48. 48.

    WereBear

    November 30, 2016 at 11:55 am

    I called my insurance company seven times because the diagnosis I needed was not in the network. They constantly said, go ahead, set it up. I found one, called them back, made sure it was all set up properly. They said it was. I said can you send me a thing that says all this? They said we are making notes. They wouldn’t send me a thing.

    You can see the next thing coming, right?

    Now they are saying I was supposed to submit a thing, first. I said there must have been a total of fifteen phone calls if you include the women who kept calling me to say there wasn’t anything in the network for me, and nobody said a thing about a thing.

    It’s now being “assessed.” I am livid and trying to not even be that, because it’s not currently life threatening and it’s not thousands and thousands of dollars and it wouldn’t do a bit of good anyway.

    Just checked… still livid. They are nice people but they apparently do not have a single clue about how the stupid thing works. And I’m supposed to figure it out?

  49. 49.

    Poopyman

    November 30, 2016 at 11:58 am

    Not at all OT:

    House Democrats voted on their leader Wednesday and Nancy Pelosi prevailed, winning 134 to 63, despite the most serious challenge to her leadership she’s faced in recent years, from Rep. Tim Ryan:

    After 14 undistinguished years in Congress, Ryan has appeared from the back bench — he literally sits in the last bench in the chamber — and forced Pelosi to fight for the top spot like never before. It’s prompted her to offer structural changes to leadership and more opportunity to the burgeoning crop of junior lawmakers who have never served in the majority.

  50. 50.

    WereBear

    November 30, 2016 at 12:02 pm

    FYI, folks, the site to share health care stories is:

    Could Happen to You

    and we welcome submissions.

  51. 51.

    Steeplejack (tablet)

    November 30, 2016 at 12:03 pm

    @Enhanced Voting Techniques:

    The Republicans have had seven years and counting to come up with a “replacement” for Obamacare. They have done nothing, and they don’t want to do anything. But now they’re going to have to admit it to everyone publicly if they actually do succeed in getting rid of Obamacare.

  52. 52.

    Days

    November 30, 2016 at 12:06 pm

    A year ago, my husband went to an out of network hospital for an emergency. Big mistake on our part. We got nailed for $70,000, balance billing. Example: $13,000 for a CT Scan, just ridiculous prices.

    A few months ago, my husband needed surgery. While he was waiting to be wheeled in, we pressed the anesthesiologist on if she was in network. It’s scary. Most people don’t know and should. The balance billing problem won’t be fixed in the next 4 years, I’m willing to bet.

  53. 53.

    Steeplejack (tablet)

    November 30, 2016 at 12:07 pm

    @WereBear:

    You should start recording every phone call you have with them.

  54. 54.

    Pogonip

    November 30, 2016 at 12:12 pm

    @Steeplejack (tablet): Concur!

  55. 55.

    WereBear

    November 30, 2016 at 12:20 pm

    @Steeplejack (tablet): Good idea. Starting… now.

    Interestingly, I was told they will be “going over the recordings” but I course I do not have them.

  56. 56.

    Another Scott

    November 30, 2016 at 12:34 pm

    @WereBear: Make sure you cover yourself in case there are local laws about recordings (e.g. presumably you have to let them know that you’ll be recording).

    Good luck!

    Cheers,
    Scott.

  57. 57.

    PST

    November 30, 2016 at 12:40 pm

    I write only to provide a contrasting experience, not to defend the crazy quilt of the current billing/insurance system. I’ve had a great deal of medical treatment this year, but everything from one organization. The total price tag is approaching $100,000, but there have been no out-of-network surprises and no attempts to stick me for anything the insurer declined to pay for. It’s all been free since I hit my out-of-pocket maximum: painful but not disastrous. Health insurance can work as designed, but I suspect it only happens with a high priced product.

  58. 58.

    Juice Box

    November 30, 2016 at 12:42 pm

    @Calouste: Sure, you could do that, but most likely you’re going to get a heckuva push back from the people who will be out of a job. It’s a political issue. I’m not arguing that wasting that money is a good idea — far from it — but if saving that money is the desired outcome, it does mean putting people out of work.

    There is also the problem of training them for which jobs? Above-minimum-wage burger flipping? The solar industry? We progressives talk a lot about retraining people without ever coming up with the slightest outline of a concrete plan. This isn’t the vestigial coal industry.

  59. 59.

    Juice Box

    November 30, 2016 at 12:49 pm

    @liberal: The AMA is a lobbying group. About one forth of American MDs and 0% of DOs belong to it. Twenty years ago about half of all MDs belonged. Its membership skews male, Southern, white, and surgical specialities. State medical association and even specialty organizations are also slowly dying. It’s a lot like union membership.

  60. 60.

    Barbara

    November 30, 2016 at 12:54 pm

    @Another Scott: Oh, I totally agree. I think this situation is outrageous. I think that all hospitals should be responsible for the billing and payment of hospital based physicians that are selected by someone other than the patient and let them figure out how much to pay the anesthesiologist.

  61. 61.

    workworkwork

    November 30, 2016 at 1:09 pm

    @BigRed: I’m with Kaiser as well and I’ve been very happy with them.
    Despite the high deductible for my ACA plan ($5000), I like that they have more of a focus on wellness and prevention.
    That, in addition to the ACA out-of-pocket limit, means that after my recent splenectomy my care is covered through the end of the calendar year.

  62. 62.

    Richard Mayhew

    November 30, 2016 at 1:13 pm

    @J.: It’s not a bad idea if it is well thought out. The biggest problem is 218-51-1-5

  63. 63.

    Pogonip

    November 30, 2016 at 1:14 pm

    @Richard Mayhew: What does that string of numbers mean?

  64. 64.

    workworkwork

    November 30, 2016 at 1:17 pm

    @Botsplainer: Plus, in a Stand Your Ground state, you can legitimately claim that you feared for your life.

  65. 65.

    joel hanes

    November 30, 2016 at 1:24 pm

    I don’t know how you do it, Richard.

    From all the evidence, you seem to be a wonderful, caring guy, upstanding, thoughtful. But the need to

    call the in-network hospital to see if the anesthesiologist would be in-network if a laboring mother to be needed/wanted an epidural.

    is yet another piece of evidence that for-profit health insurance is inherently a morally degenerate enterprise with the ethics of a scorpion. And that’s what you do for a living.

  66. 66.

    Another Scott

    November 30, 2016 at 1:29 pm

    @Pogonip: A majority in the House, a majority in the Senate, a President who agrees, and a SCOTUS that agrees.

    HTH.

    Cheers,
    Scott.

  67. 67.

    MikeB

    November 30, 2016 at 1:40 pm

    Been there for many years. Wife had a liver transplant in ’06 and I’ve had to fight what I call the “Weasel Department” at private
    insurers on a regular basis.
    The puzzling thing about Ryan’s wet dream of phasing out Medicare is that nobody seems to be talking about where the private
    insurers stand on this. According to my conservative insurance broker, who is a lobbyist for the industry in my state, the LAST thing
    the insurers want is to have to deal with the Medicare population. They’ve done nothing but whine about all the money they’re losing
    on Obamacare, so it’s hard to see how they’ll be wanting to cover oldsters like me. Medicare is the equivalent of a government bailout for
    health insurers.

  68. 68.

    EBT

    November 30, 2016 at 1:49 pm

    That sort of situation from the end of the OP should be treated as if it was information given in bad faith.

  69. 69.

    Adria McDowell (formerly LurkerExtraordinaire)

    November 30, 2016 at 1:51 pm

    @Gindy51: THIS!! TriCare is a god send, and if you call with questions or concerns, they will bend over backward to help you. They’ll even resubmit stuff if they have to. But even with TriCare, you can still accidently see a doctor not in their network (I’ve mentioned this before, but it involved me, a prenatal appointment, and the doctor I was supposed to see being out on vacation for 2 weeks while I needed a check up in between my husband’s duty stations). We didn’t pay a dime for the birth of my daughter in a German hospital, and I could stay up to a week if I wanted. We currently pay about $52 a month to cover my husband, myself, our daughter and my step-son and a step-daughter. THIS IS THE RATE EVERYONE SHOULD PAY!

    The dental insurance for military retirees is pretty good, too. While it doesn’t cover everything, they are really nice, friendly, and willing to help.

  70. 70.

    Adria McDowell (formerly LurkerExtraordinaire)

    November 30, 2016 at 2:04 pm

    @liberal:

    As some point, both private insurance and private providers will become unaffordable due to multiple market failures and spiralling.

    Well, this isn’t about health care, but this is the exact opposite of what is being argued with flood insurance. They want to abolish the National Flood Insurance Program (because, hey, who knew- flood recovery is expensive), so they want everyone to get private insurance. Minus the subsidies that plenty of people have been getting when they purchase (or are required to purchase) flood insurance. So of course, how cheap do you think those flood insurance policies will be a month? Not as cheap as these fools think.

    Again, not about health care, but we have a “socialized” insurance system in place for floods, and people don’t like it because it’s too expensive. You know, like a national health care plan would be. They forget just how expensive the “free” market can get. Which is what vets would want to privatize the VA will find out the hard way.

  71. 71.

    Apsalar

    November 30, 2016 at 2:06 pm

    I don’t even know how you’d know which anesthesiologist to check for. I had a baby 2 years ago, and one anesthesiologist gave me the epidural, and several hours later, another one took it out. Fortunately they were both in-network, as it turned out.

  72. 72.

    RaflW

    November 30, 2016 at 2:33 pm

    Item #5 in Trump’s campaign website on Health Reform:

    5. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.

    Every time this fails starting Jan. 21st, we need to screw DJT to the wall for it. OK, maybe give him his first 100 days, but I’m not sure why we should. His followers think gov’t happens by magic, so we should play along.

    Seriously, any surprise billing incident such as an out-of-network attending doc in a surgery should be Donald Trump’s personal fault. He said we’d have price transparency, dammit. Where is it!

  73. 73.

    RaflW

    November 30, 2016 at 2:34 pm

    Trump website: “5. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.”

  74. 74.

    RaflW

    November 30, 2016 at 2:37 pm

    So we need to hold him and the GOP to this. When surprises happen in costs as in the OP, we need to attack Trump and the GOP for failing to keep their promise.

    As in the newer BJ thread about using policy as a lever to get at Republicans, health care seems like a massive opportunity. You break it you bought it needs to apply biggly.

    (Sorry for the split comment, but FYWP is eating my posts as canned lunch meat.)

  75. 75.

    VFX Lurker

    November 30, 2016 at 3:10 pm

    Jane Bryant Quinn warned of the dangers of unexpected out-of-network billing in her personal finance book, Making the Most of Your Money Now. It’s one of the main reasons I choose Kaiser Permanente over fee-for-service insurers.

  76. 76.

    Anonymous patient

    November 30, 2016 at 5:29 pm

    @beth:

    Had a good friend who was gardening and was bitten by a copperhead snake – her ER bill included a one line charge for anti-venom injection – $67,000.

    WOW.

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