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Especially with last minute doctor allocations. Arrive for your critical surgery that must be done ASAP and get met by an anesthesiologist (thank you spellcheck

by olliej 5y ago

Especially with last minute doctor allocations. Arrive for your critical surgery that must be done ASAP and get met by an anesthesiologist (thank you spellchecker) who says "by the way I'm out of network, do you agree to pay me an arbitrary amount? If not, your surgery is cancelled." Then if you do say no, could the hospital then charge you for cancelling surgery at late notice? Especially given insurance generally doesn't cover such fees. Honestly any law that doesn't say "if the facility is in network, the insurance company must cover all costs as in network" and get rid of this bullshit concept of "out of network" people in an in network facility is fundamentally insufficient.

akomtu 5y ago
I usually compare US hospitals to upscale mexican cartels. A cartel gives you a choice: "pay this arbitrary amount now, or have your arm chopped off". A hospital gives you the same choice, but does that with style: "sign these papers here and here, saying you agree to pay us arbitrary amount, or our surgeon, who's supposed to save your arm, isn't available today."
lotsofpulp 5y ago
The anesthesiologist scenario is addressed in the recent legislation that went into effect Jan 1, 2022 (Consolidated Appropriations Act of 2021): https://www.cms.gov/nosurprises/consumer-protections/What-are-the-new-protections https://www.cms.gov/nosurprises/consumer-protections/What-ar... >Ban out-of-network charges and balance billing for ancillary care (like an anesthesiologist or assistant surgeon) by out-of-network providers at an in-network facility.
- kelnos 5y ago
  Right, but the bit I quoted above seems to suggest that this "ban" is weak and can be circumvented by the out-of-network doctor explaining there will be extra, non-covered charges, and then getting you to sign a waiver saying that's ok. If not signing that waiver means your surgery gets canceled (especially in an emergency situation), most people will feel coerced to sign. Hell, most people will probably feel coerced to sign in most situations.
  - deleted 5y ago
    [deleted]
  - lotsofpulp 5y ago
    Yes, the article links to this form: https://www.cms.gov/files/document/standard-notice-consent-forms-nonparticipating-providers-emergency-facilities-regarding-consumer.pdf https://www.cms.gov/files/document/standard-notice-consent-f... Which instructs the provider to list the "good faith estimated cost" on page 4. Presumably, this will then bind the provider to having to deal with you via the dispute resolution process: https://www.cms.gov/nosurprises/consumers/medical-bill-disagreements-if-you-are-uninsured https://www.cms.gov/nosurprises/consumers/medical-bill-disag... Of course, the effectiveness of all of this remains to be seen, and will depend on what kind of teeth this dispute resolution process has: >If after getting your bill you realize that any of your providers or facilities billed you for an amount that’s $400 or more than what’s on your good faith estimate, you can use a new dispute resolution process to request that an independent third-party, called a dispute resolution entity, review your case and determine an appropriate payment. This process is referred to as “patient-provider dispute resolution.” The dispute resolution entity will review the good faith estimate, your bill, and information submitted by your provider or facility to determine if you should pay the amount on your good faith estimate, the billed charge, or an amount in between the two. There’s a $25 non-refundable administrative fee to start this process.

by olliej 5y ago

akomtu 5y ago

I usually compare US hospitals to upscale mexican cartels. A cartel gives you a choice: "pay this arbitrary amount now, or have your arm chopped off". A hospital gives you the same choice, but does that with style: "sign these papers here and here, saying you agree to pay us arbitrary amount, or our surgeon, who's supposed to save your arm, isn't available today."

lotsofpulp 5y ago

The anesthesiologist scenario is addressed in the recent legislation that went into effect Jan 1, 2022 (Consolidated Appropriations Act of 2021): https://www.cms.gov/nosurprises/consumer-protections/What-are-the-new-protections https://www.cms.gov/nosurprises/consumer-protections/What-ar... >Ban out-of-network charges and balance billing for ancillary care (like an anesthesiologist or assistant surgeon) by out-of-network providers at an in-network facility.

kelnos 5y ago
Right, but the bit I quoted above seems to suggest that this "ban" is weak and can be circumvented by the out-of-network doctor explaining there will be extra, non-covered charges, and then getting you to sign a waiver saying that's ok. If not signing that waiver means your surgery gets canceled (especially in an emergency situation), most people will feel coerced to sign. Hell, most people will probably feel coerced to sign in most situations.
- deleted 5y ago
  [deleted]
- lotsofpulp 5y ago
  Yes, the article links to this form: https://www.cms.gov/files/document/standard-notice-consent-forms-nonparticipating-providers-emergency-facilities-regarding-consumer.pdf https://www.cms.gov/files/document/standard-notice-consent-f... Which instructs the provider to list the "good faith estimated cost" on page 4. Presumably, this will then bind the provider to having to deal with you via the dispute resolution process: https://www.cms.gov/nosurprises/consumers/medical-bill-disagreements-if-you-are-uninsured https://www.cms.gov/nosurprises/consumers/medical-bill-disag... Of course, the effectiveness of all of this remains to be seen, and will depend on what kind of teeth this dispute resolution process has: >If after getting your bill you realize that any of your providers or facilities billed you for an amount that’s $400 or more than what’s on your good faith estimate, you can use a new dispute resolution process to request that an independent third-party, called a dispute resolution entity, review your case and determine an appropriate payment. This process is referred to as “patient-provider dispute resolution.” The dispute resolution entity will review the good faith estimate, your bill, and information submitted by your provider or facility to determine if you should pay the amount on your good faith estimate, the billed charge, or an amount in between the two. There’s a $25 non-refundable administrative fee to start this process.