Tag Archives: differential payment

States, consumer groups take steps to help with ‘surprise’ medical bills

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo by Upupa4me via Flickr.

Amy Trent, a health care reporter for the News & Advance in Lynchburg, Va., found an ideal source for an article about surprise medical bills. She wrote about Leighton Dodd, the 83-year-old former mayor of this city of 75,000 in the foothills of the Blue Ridge Mountains.

Dodd, a cancer patient, in 2014 had seen the monthly cost of his chemotherapy treatment go from $5,800 in September to $16,124 in October. The reason: Centra Health made Dodd’s physician group an outpatient department.

While everything else about Dodd’s care was unchanged, the new owners of his oncology practice raised the cost of Dodd’s care by 278 percent. Dodd’s bill jumped sharply because of what are called site of service differential payments, which we covered last month in a tip sheet and last year in a blog post. The federal Centers for Medicare & Medicaid Services wants to eliminate these differential payments. Continue reading