Her stories included a patient who went to an in-network ER and was still billed nearly $8,000 and a major ER that – at the time – didn’t participate in the networks of any private health insurers, resulting in unexpected bills.
In April, Anna Wolfe, who covers health care for the Mississippi Clarion Ledger, started reporting on what appeared to be staggeringly high bills for using the emergency room at the Batson Children’s Hospital, in Jackson. The hospital is part of the University of Mississippi Medical Center, the only academic medical center in the state.
Parents who brought their children to the ER were being charged thousands of dollars in unreasonable emergency room facility fees that do not match the level of care received, Wolfe reports. Since that article was published April 15, Wolfe has continued to cover the complex ways the hospital calculates its charges. In the bills Wolfe reviewed, the hospital adds facility fees for ER visits, fees that are based on the level of care administered. Continue reading
Under the Affordable Care Act, certain high-value preventive services – such as colonoscopies – are supposed to be free. No co-pay for the patient.
But some patients are getting charged when they don’t expect it and perhaps shouldn’t be.
And there is a lot of inconsistency on who gets charged, depending on individual circumstances, what state they live in and what health plan they have. Part of it is confusion about what constitutes “screening” and what constitutes treatment. Plus doctors vary in how they “code” and bill for these services.
The variance is not just based on the individuals’ health circumstances (i.e. whether they had a polyp or not), but what state they live in, what health plan they have. The whole thing is generating confusion and complaints – and it’s a good story.
The thinking behind making preventive care free – specific preventive services, graded A or B by the U.S. Preventive Services Task Force (USPSTF) – is that it makes it more accessible. It’s easy to put off – and put off and put off – screening. Research has shown that having to pay for it is an additional barrier.
The Tulsa World‘s Ziva Branstetter has, for months now, been doggedly investigating the billing practices of the Emergency Medical Services Authority, an agency that provides ambulance service to many residents in and around Tulsa and Oklahoma City. The service is largely funded by utility fees which, unless users specifically opt out, should cover the payers’ out-of-pocket costs.
Instead, Branstetter has found, EMSA has followed a number of apparently deceptive billing practices, including sending bills that list a “due from patient” balance of something like $1,100, even though that amount is actually covered by the utility fee. It also unilaterally implemented a policy making patients responsible for the balance if they don’t provide insurance information within 60 days, while providing lavish benefits to employees and executives.
Branstetter’s latest efforts have been directed toward innovative ways of proving EMSA’s sketchy billing practices, as well as uncovering the details of benefits given to the public utility’s CEO. For a full list of Branstetter’s stories on the subject, databases and documents, as well as a summary of the issues at hand, visit the World‘s excellent landing page for the investigation.
Spurred by higher co-pays and the ability to estimate billing amounts faster, more doctors are requiring patients to pay their full co-pays at the time of the visit, Francesca Lunzer Kritz reported in The Washington Post.
“It’s a paradigm shift from what most consumers are used to at their doctor’s office,” says Red Gillen, a San Francisco-based analyst with consulting firm Celent, who last month published a report on doctors seeking upfront payment from their patients. Gillen says that until recently, insurers paid so much of the cost of medical care that medical providers, including doctors, labs and hospitals, focused their fee recovery efforts on the companies. But in the past few years, Gillen says, employers and insurers have shifted more costs to consumers in the form of higher co-pays, higher co-insurance and higher deductibles, making those payments an increasingly large share of doctors’ incomes. According to Gillen, consumer out-of-pocket spending as a percentage of all health-care spending rose to 12 percent last year, and is expected to continue rising.
Patient advocates regard the faster billing process as a positive for consumers, Lunzer Kritz found, but some are concerned that patients are not warned about their doctor’s billing practices and that higher up-front payment demands may discourage sick people from seeking care.