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> [surprise bills]… often stem from patients unwittingly receiving care from out-of-network providers… If you do not have the agency to select an in-network pr

by teeray 2y ago

> [surprise bills]… often stem from patients unwittingly receiving care from out-of-network providers… If you do not have the agency to select an in-network provider (because you are mortally wounded / incapacitated / etc.), then the out-of-network provider should be legally transmuted into an in-network one. The insurer should be compelled to pay, and the provider compelled to accept it.

readthenotes1 2y ago
I believe that's the way it works. And then you have to transfer to in network provider as soon as humanly possible (perhaps not as humanely possible...)
- deathanatos 2y ago
  One of the problems here is that the patient can believe they're at an in-network provider — and be correct about that — and still get hit with "out of network" charges. One of the linked articles[1] explains it slightly better: > Surprise medical bills happen when a doctor or other provider who isn’t in a patient’s insurance network is unexpectedly involved in a patient’s care. Patients may go to a hospital that accepts their insurance, for example, but get treatment from emergency room physicians or anesthesiologists who don’t — and who then send patients big bills directly. I've seen this in my own medical billing: often times, I will get bills (to the insurance) from "providers" I had no (direct) interaction with. And that's the thing: if a in-network provider contracts/vendors/(who knows, I don't know how their business is structured) to some other company, you get billed "randomly". Sometimes I can piece together exactly what action caused it (e.g., okay, that ultrasound is this random charge), but not all the time. Insurers refuse to help: they claim it's not their problem, as they're not billing you. Providers will claim they know nothing; after all, it isn't them that billed you. [1]: https://www.nytimes.com/2021/07/01/upshot/surprise-medical-bills-biden.html https://www.nytimes.com/2021/07/01/upshot/surprise-medical-b...
  - ipython 2y ago
    This +1000. The whole billing / insurance system is intended to wear you down in a cascading swarm of bullshit. You want to know if a doctor is in network? Good luck, because the insurance company clearly states that they only provide that information on a best effort basis. The doctor can’t answer, as they refer you back to your insurance company. You want an outpatient surgery? Great! Make sure your doctor and facility is in network, right? Oops, wrong again! You forgot about the anesthesiologist who you can’t pick ahead of time and is rarely in network. Good luck figuring that out later! It’s intended to wear you down until you’re afraid of your “rating” aka credit score tanking enough that you just pay up.
    - maxerickson 2y ago
      There was legislation that changed this a couple years ago. https://www.cms.gov/nosurprises/ending-surprise-medical-bills https://www.cms.gov/nosurprises/ending-surprise-medical-bill...
      - ipython 2y ago
        All well and good until you sign away those rights in one of the many forms you fill out- see for example this excerpt from one of my local hospital websites (emphasis mine) It’s trivial to be coerced into signing one of these agreements when you’re in a high stress high stakes environment. > If you get other types of services at these in-network facilities, out-of-network providers can't balance bill you, _unless you give written consent and give up your protections._
  - pushedx 2y ago
    Last year I had minor surgery, and before the procedure started, I asked the anaesthesiologist if she was out of network. Her response: laughter. Very comforting when I was about to trust her with my life. Turns out she was out of network, and the cost of the anesthesia on top of my in-network hospital bill was around $1050.
  - metalcrow 2y ago
    Can you simply just not pay? What are the legal consequences in that case? Effectively some random 3rd party is requesting you pay them for something you didn't ask for or contract them to do.

by teeray 2y ago

readthenotes1 2y ago

I believe that's the way it works. And then you have to transfer to in network provider as soon as humanly possible (perhaps not as humanely possible...)

deathanatos 2y ago
One of the problems here is that the patient can believe they're at an in-network provider — and be correct about that — and still get hit with "out of network" charges. One of the linked articles[1] explains it slightly better: > Surprise medical bills happen when a doctor or other provider who isn’t in a patient’s insurance network is unexpectedly involved in a patient’s care. Patients may go to a hospital that accepts their insurance, for example, but get treatment from emergency room physicians or anesthesiologists who don’t — and who then send patients big bills directly. I've seen this in my own medical billing: often times, I will get bills (to the insurance) from "providers" I had no (direct) interaction with. And that's the thing: if a in-network provider contracts/vendors/(who knows, I don't know how their business is structured) to some other company, you get billed "randomly". Sometimes I can piece together exactly what action caused it (e.g., okay, that ultrasound is this random charge), but not all the time. Insurers refuse to help: they claim it's not their problem, as they're not billing you. Providers will claim they know nothing; after all, it isn't them that billed you. [1]: https://www.nytimes.com/2021/07/01/upshot/surprise-medical-bills-biden.html https://www.nytimes.com/2021/07/01/upshot/surprise-medical-b...
- ipython 2y ago
  This +1000. The whole billing / insurance system is intended to wear you down in a cascading swarm of bullshit. You want to know if a doctor is in network? Good luck, because the insurance company clearly states that they only provide that information on a best effort basis. The doctor can’t answer, as they refer you back to your insurance company. You want an outpatient surgery? Great! Make sure your doctor and facility is in network, right? Oops, wrong again! You forgot about the anesthesiologist who you can’t pick ahead of time and is rarely in network. Good luck figuring that out later! It’s intended to wear you down until you’re afraid of your “rating” aka credit score tanking enough that you just pay up.
  - maxerickson 2y ago
    There was legislation that changed this a couple years ago. https://www.cms.gov/nosurprises/ending-surprise-medical-bills https://www.cms.gov/nosurprises/ending-surprise-medical-bill...
    - ipython 2y ago
      All well and good until you sign away those rights in one of the many forms you fill out- see for example this excerpt from one of my local hospital websites (emphasis mine) It’s trivial to be coerced into signing one of these agreements when you’re in a high stress high stakes environment. > If you get other types of services at these in-network facilities, out-of-network providers can't balance bill you, _unless you give written consent and give up your protections._
- pushedx 2y ago
  Last year I had minor surgery, and before the procedure started, I asked the anaesthesiologist if she was out of network. Her response: laughter. Very comforting when I was about to trust her with my life. Turns out she was out of network, and the cost of the anesthesia on top of my in-network hospital bill was around $1050.
- metalcrow 2y ago
  Can you simply just not pay? What are the legal consequences in that case? Effectively some random 3rd party is requesting you pay them for something you didn't ask for or contract them to do.