University of Michigan law professor Nicholas Bagley and I outlined some significant potential cost barriers to care for COVID19 (and implicitly everything else) in the New York Times yesterday:
A patient with insurance through work or the health-insurance exchanges can be surprise-billed when she seeks medical care at a hospital or clinic that’s in her insurance “network” — but then receives medical care from a person or an institution that’s outside the network.
That out-of-network provider will first send a bill to the patient’s insurer. But if the insurer doesn’t pay the full amount, the provider may bill the patient directly for the remaining balance. Because the provider is basically free to name its own price, these surprise bills can be wildly inflated…
In a coronavirus pandemic, a patient can do everything right and still face substantial surprise bills. Take someone who fears that she may have contracted Covid-19. After self-quarantining for a week, she develops severe shortness of breath. Her partner rushes her to the nearest in-network emergency room. But she’s actually seen by an out-of-network doctor — who may soon send her a hefty bill for the visit.
The ACA provides some protection for in-network billing through a maximum out of pocket limit but that number can be very high. Medicare and Medicaid have strong surprise billing protections while employer insurance regulated by ERISA is the wild west.
We, as a society, need to get people who have medical needs the care that they need. Fear of a surprise bill is a barrier to care. It is not the only barrier, but it is one that is amenable to policy changes instead of requiring both policy changes and the deployment of physical resources. Eliminating the fear of a surprise bill will marginally help.
WereBear
Worse, this situation is exponential for many people: no sick leave, no insurance, no savings; tourism related, no job.
Betty Cracker
This tweet is the most eloquent indictment of the U.S. healthcare system I’ve ever seen.
oldster
Our own David Anderson publishing in the NYT!
And to think that we knew him when he was a nerdy little pisher at BJ.
They grow up so fast these days.
Baud
You make the NYT a little less garbage-y,
PenAndKey
This, quite frankly, shouldn’t even be legal. The fact that you can go to a hospital that’s in-network for your insurance and still be treated by individuals who work at the hospital that aren’t in-network makes a complete mockery of the idea that healthcare consumers have any realistic hope of being able to make informed financial decisions when it comes to healthcare.
Amir Khalid
I think the term “surprise billing” doesn’t convey strongly enough the unexpected financial blow to the insured. I’d go with “ambush billing.”
PenAndKey
@Amir Khalid: And I’d call it “fraud by deception”, but enough lobbyists have been involved that the actual law disagrees.
JPL
@oldster: Did you see the link to his twitter feed? @bjdickmayhew lol
oldster
@JPL:
Yup. You can take the boy out of BJ, but you can’t take the BJ out of the boy.
(Same goes for dick, I suspect.)
DAVID ANDERSON
@JPL: I am all class, MFer
PST
One of my kids just came home to find a summons and complaint rubber-banded to his door knob. It is evidently for anesthesia services for a procedure at an in-network hospital 38 months ago — long enough ago that we can’t even get the explanation of benefits from the insurance company web site. In all that time he never received a bill, but he has moved a couple of times, and of course he could be mistaken. The statute of limitations for collecting a medical bill is five years in his state, and service by leaving it at the house seems to be legal. We can only infer — based mostly on the amount — that it is balance billing for the full rack rate on something that must have been out of network, so instead of an $85 or so co-insurance it’s more like $750 now (with interest). It won’t break us, but learning of something like this by being sued is a major annoyance. It sure makes single payer look good.
dnfree
I saw this on Facebook first thing this morning: “In this pandemic, a patient can do everything right and still face substantial medical bills, write David Anderson and Nicholas Bagley.”. I thought to myself that Mayhew guy has sure come a long way.
Brad F
David
Legislation = gold standard, and in no way am I advocating for anything else, but woe is the provider seeking redress in a court of law for a Covid related unpaid, OOP expense several months down the road. Any judge worth his or her weight will tell the plaintiff to pound sand and eat gristle in 12′ x 12′ cell for a month. I can’t see any rational person seeing this as anything different than price gouging during a public health emergency. Again, no small comfort, but in this case, reality will not likely equal theory in a (very high) majority of cases.
Brad
David Anderson
@BradF
I am an advocate of literal tarring and feathering for the MBA asshole who thought Martin Shrekeli was not ambitious enough.
I agree with you that the overwhelming majority of providers won’t do this either because they are not thuggish sociopaths or they are smart sociopaths who listen to their lawyers who will be telling them exactly what you just said.
But there will be people who will try this (see Tennessee Hand Sanitizer Guy)
Brad F
@David Anderson:
btw, did you see what happened to TN hand sanitizer guy?
His life is kaput. If you didnt read NYT follow up, you should.
“The arc of the moral universe is long, but it bends toward justice”
https://www.nytimes.com/2020/03/15/technology/matt-colvin-hand-sanitizer-donation.html?searchResultPosition=1
Cathie from Canada
When Canada introduced medicare in the 1960s (it took several years to spread across the country) one of the biggest fights was, and still is, against what we call “extra billing” — doctors, and medical professionals of all types, have tried for decades to get the provinces to agree to allow them to direct bill consumers over and above what they receive by the medicare-negotiated rates for services. Provinces have sometimes been desperate for doctors, particularly specialists, particularly ones willing to work in rural areas, and so the provincial governments would go along with some of these extra billing schemes, more so when the provincial government is Conservative. But the federal government, through the Canada Health Act, has mainly stood fast and, in most cases, will not permit it, despite the pressure. Looking back on it, I believe that outlawing extra billing has been extremely important to keep our medicare system universal, and to maintain a rough equivalency of services across the country.