Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals

The actual price of what a medical test, procedure, exam and often prescription cost and how charges are assigned is not based on the free market. Instead, prices are agreed on via secret agreements between hospitals and insurance companies. This is the subject of the Houston Healthcare Initiative podcast with Dr. Steven Goldstein. To hear the Houston Healthcare Initiative podcast, please visit: SoundCloud, Apple Podcasts, iHeart, PlayerFM, or the Houston Healthcare Initiative web site. Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals.

Pay More Attention

Price Transparency
Price transparency from insurance companies and medical companies is a rare thing.

Most people get health insurance from their employer which is the reason, so few pay much attention to the price of the medical services and pharmaceuticals that Americans purchase. Employer funded insurance pays for most of what is charged with individuals picking up a smaller deductible. But according to neurologist Dr. Steven Goldstein, it is past time to start devoting attention to not just what is charged but how the health insurance companies, and the medical community decides what to charge and why. Spoiler Alert: it is not based on the free market.

The idea that pricing for medical services as paid by insurance companies are artificially set and not competitive at all. They are agreed to in advance by the hospital and the insurance company, not disclosed to the public, and we are all led to believe that our insurance providers were negotiating on behalf of the people that pay the premiums.

It Is Expensive But…

The fact that the charges for visits to the doctor, hospital and pharmacist are mostly paid for by employer funded insurance does not make us any less likely to get both overcharged and underserved. It is a lack of transparency that makes medical costs so high. It was not wrong to believe that research, new equipment, and pharmaceutical discovery were what was behind the increase in healthcare prices; they account for some. “The issue is that patients do not know the actual price of services,” Dr. Goldstein told his listeners. “The list price is the price charged to patients without insurance. Each insurance company negotiates a discounted price.”

Thus, there are multiple discounted prices depending on the insurance company plus a different price for Medicare and Medicaid. These prices have traditionally been secret. There is no competition between hospitals based on price. “Medicare sets the price standard based on costs,” he said. “Thus, hospitals are cost plus operations with little incentive to reduce costs.”

Why Not Just Pay Cash?

Cash prices are often much less than what is charged even to the insurance companies. People often can secure better deals if they don’t use their insurance. A 2016 Wall Street Journal investigation found that hospitals frequently offer far better deals for people who pay in cash rather than use their insurance. “Price transparency allows individuals to shop for the best nonemergency deal. It would also force hospitals to compete, thus saving consumers money. It gives them a choice,” Dr. Goldstein said. The way any of us chooses to spend our money is the most democratic thing anyone can do.

Price transparency allows individuals to find the best non-emergency deal. It would also force hospitals to compete, thus saving consumers money. “If prices were known, posted in public, people could shop for the non-emergency services,” Dr. Goldstein said.

About Houston Healthcare Initiative

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals

 

Why Healthcare Insurance & Hospitals Do Not Want You To Know About Pricing

Medical Price Transparency
Why Healthcare Insurance & Hospitals Do Not Want You To Know About Pricing

Transparency and the need for it in different industries is a word and requirement we hear a lot about. It should not surprise anyone that some insurers and hospital groups are working to block the implementation of federal rules that make hospital pricing transparent. They argue these will confuse consumers and potentially lead to higher costs. But there is good news. According to the New York Times, a federal judge has upheld a Trump administration policy that requires hospitals and health insurers to publish their negotiated prices for health services, numbers that are typically kept secret.

Most of us have our health insurance provided by our employers and we do not pay as much attention to the price of medical care as we do the cost of other consumer items. But maybe we should pay more attention? The fact that the charges for our visits to the doctor, hospital and pharmacist are mostly paid for by our insurance does not make us any less likely to get both overcharged and underserved. In fact, it is a lack of transparency that makes medical costs so high.

The issue is that patients do not know the actual price of services. The list price is the price charged to patients without insurance. Each Insurance company negotiates a discounted price. Thus there are multiple discounted prices depending on the insurance company plus a different price for Medicare and Medicaid. These prices have traditionally been secret. There is no competition between hospitals based on price. Medicare sets the price standard based on costs. Thus, hospitals are cost plus operations with little incentive to reduce costs.

Learn more by listening to the podcast.

For Those Who Lost Their Employer Funded Health Insurance; Resources Are Available

Provided at no charge by the Houston Healthcare Initiative.  

For Those Who Lost Their Employer Funded Health Insurance Resources Are Available

Because of the Coronavirus/Covid-19 pandemic, 25–43 million people could lose their jobs and their health insurance. People who had a serious illness before the outbreak and job loss could be dealt a literally fatal blow. Others who had symptoms and even serious accidents while unemployed and without insurance could suffer more than they would have if their insurance were in place. But there are resources available as described this week on the Houston Healthcare Initiative podcast. To learn more, go to www.houstonhealthcareinitiative.org. To hear about this on Dr. Goldstein’s podcast, please visit: Job Losses Equal Employer Funded Health Insurance Loss.

  • Testing for the Coronavirus/Covid-19 illness: testing for the Coronavirus/Covid-19 virus is free. But if the test is positive and you have the virus, the treatment for it can get expensive. Fortunately, most people recover at home. However, an estimated 15% of infected people may end up hospitalized, according to the Kaiser Family Foundation. Recent data suggests that patients who go to intensive care stay there for an average of 20 days. The Castlight Covid-19 test site finder will provide information on Coronavirus testing near you: https://my.castlighthealth.com/corona-virus-testing-sites/.
  • The Health Insurance Exchange: Open enrollment typically runs from November to January, depending on the state in which you live. But people are allowed a change in coverage when experiencing a life altering event. One such event is the loss of a job and employer sponsored health insurance. You can shop for health plans through your state’s insurance marketplace. But don’t wait around, there are 30 to 60 days to sign up after a qualifying life event before the end of that special enrollment period. Go to this link and find out if you qualify for coverage: https://www.healthcare.gov.
  • Medicaid: Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities in all fifty states.  In some states the program covers all low-income adults below a certain income level. But do not assume that you do or do not qualify. There are online resources available from the U.S. Department of Health and Human Services along with state references to guide you. Visit the official U.S. government Medicaid site to see of you are eligible: https://www.medicaid.gov.
  • CHIP: CHIP stands for Children’s Health Insurance Program. If your children need health coverage, they may be eligible for the Children’s Health Insurance Program (CHIP). CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women. Each state offers CHIP coverage and works closely with its state Medicaid program. Get all the details, go to: https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/.
  • Faith Based Cooperatives: Faith-based plans are designed to provide essential coverage for the good health and physical well-being of their members. In return they expect members to live faith-based lives in adherence to the principles behind such plans. As such, faith-based plans will not cover hospital costs that stem from activities they deem immoral or unessential. Faith based plans most often share expenses among members. Each member pays a monthly premium. When one of the members becomes ill or needs treatment for an injury, his or her contributions cover the expenses, in conjunction with the collective input of fellow members. As such, the premiums are lower in comparison to those of traditional health care. These operate with exemptions to the mandates of the Affordable Care Act, also known as Obama Care. There are several options. Here are a few:Medi-Share, Liberty HealthShare, Samaritan MinistriesOneShare, Christian Healthcare Ministries.

This is not an exhaustive list for those who lost their employer funded health insurance but is some go the most popular ones that are available.

About Houston Healthcare Initiative And Dr. Steven Goldstein

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.

The Healthcare Not Received During the Coronavirus/Covid-19 Pandemic

From Heart Attacks to Cancer Screenings and Chemotherapy

During the Coronavirus/Covid-19 pandemic, people who did not have symptoms of the disease put themselves at risk as those with chronic conditions missed treatments, skipped appointments and chose not to report serious symptoms; this is the healthcare not received during the coronavirus/covid-19 pandemic. Many who lost their employer funded health insurance also missed schedules and treatments. Add to this the fear of visiting a doctor’s office or clinic with reported cases of Coronavirus/Covid-19 on the uptick, another health crisis may be on the horizon.

This was one of the issues affecting the American public discussed by Houston based neurologist Dr. Steven Goldstein on his regular podcast. The Houston Healthcare Initiative podcast can be heard on: Soundcloud, iHeart, Spotify, or iTunes. To learn more about the Houston Healthcare Initiative, go to www.houstonhealthcareinitiative.org.

Cancer Screenings Plummet

No Visitors
Patients who may need to be seen in the office are choosing not to go to the doctor for lots of reasons.

In March and April, patients were asked to postpone appointments that were not urgent. According to a white paper published by ‘Epic Health Research Network’ cancer screenings for cervix, colon, and breast cancer decreased between 86% – 94% in March, 2020. Care for heart attacks, organ transplants, high blood pressure and diabetes fell in March and remain significantly lower compared to the same time in 2019. “There is a 20% decrease in the number of interactions between patients and their oncologists during the COVID-19 pandemic,” Dr. Goldstein told his listeners. “Anytime a screening is delayed, it means that detection and early treatment are too, plus important therapy on advanced cancer are not administered.

Some Need To Be Seen

Many physicians, like Dr. Goldstein, ramped up their telemedicine capabilities in March and see patients that way. But there are still times when a patient needs to be seen. Instances where patients have symptoms that include shortness of breath is one. This symptom could signal heart failure, asthma, pneumonia or even the Covid-19 virus. A diagnosis like that cannot be done over the phone. “Patients and their families should err on the side of caution, contact their doctor and allow their physician the opportunity to make the right decision for the best treatment,” Dr. Goldstein said.

What Concerned Patients Can Ask

For those who believe or are told they must get in to see a doctor, and there is time available in a non-emergency, Dr. Goldstein has some potential questions to pose.

  • Does everyone on staff and patients wear masks?
  • Are the number of persons allowed in the office limited?
  • Has everyone on staff been tested for COVID-19?
  • Are cleaning protocols sufficient to manage waiting rooms, offices, and labs?
  • Has the patient taken responsibility for social distancing, hand washing and mask wearing themselves?

According to Dr. Goldstein, “we have a responsibility to our patients to provide the most appropriate and effective care possible while at the same time keeping potential exposure to the Coronavirus/Covid-19 virus to a minimum.”

About Houston Healthcare Initiative And Dr. Steven Goldstein

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.

Job Losses Equal Employer Funded Health Insurance Loss

Closed for Coronavirus

Here Are Some Resources

Even with fewer jobs lost in May than anticipated Americans now experience an unemployment rate of 13.3% or 21 million people out of work due to the coronavirus/covid-19 pandemic. On top of lost income, loss of employer provided health insurance makes the cost even higher for those who through no fault of their own find themselves in a very challenging situation. On his podcast this week, Dr. Steven Goldstein describes how job losses equal employer funded health insurance loss and some available and often free resources for those who need health insurance. To listen to the podcast go to: Soundcloud, iHeart, Spotify, or iTunes. Or click here to listen:

 

Double Loss; Job and Health Insurance

Most Americans rely on their employers to provide health insurance for them and their families and when those jobs disappear so does the coverage. “It is extremely important that people get some type of coverage when they have lost their health insurance,” Dr. Goldstein told his listeners. “The available things to look into are COBRA, spouse insurance, faith-based cooperatives, enrollment on the insurance exchange (Obama Care), Medicaid and CHIP.”

COBRA Coverage

COBRA allows employees (and their families) who would otherwise lose their group health coverage due to certain life events to continue their same group health coverage. The former employee generally pays the full monthly rate and not the discounted one for their health insurance. Under COBRA, group health plans must also provide covered employees and their families with certain notices explaining their COBRA rights. The revised model notices provide additional information to address COBRA’s interaction with Medicare. The model notices explain that there may be advantages to enrolling in Medicare before, or instead of, electing COBRA.

State Insurance Exchange

While typically only available during certain months of the year, the state insurance exchange can open for those who experience a ‘life changing’ event. One such event is the loss of a job and employer sponsored health insurance. “You can shop for health plans through your state’s insurance marketplace,” Dr. Goldstein said. “But don’t wait around, there are 30 to 60 days to sign up after a qualifying life event before the end of that special enrollment period.”

Spouse Insurance

In households where a spouse’ employer offers health insurance; those benefits may be available. “It is easy enough to find out if a spouse’s job offers health insurance and sign on for that,” Dr. Goldstein said.

Faith Based Health Cooperatives

Faith based plans most often share expenses among members. Each member pays a monthly premium. When one of the members becomes ill or needs treatment for an injury, his or her contributions cover the expenses, in conjunction with the collective input of fellow members. “As such, the premiums are lower in comparison to those of traditional health care,” Dr. Goldstein said. “These operate with exemptions to the mandates of the Affordable Care Act, also known as Obama Care.”

Medicare

Eligibility for Medicare is based on income and the size of family. Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities in all fifty states.  In some states the program covers all low-income adults below a certain income level. “But do not assume that you do or do not qualify,” said Dr. Goldstein. “There are online resources available from the U.S. Department of Health and Human Services along with state references to help guide you.”

CHIP

CHIP stands for ‘Children’s Health Insurance Program.’ CHIP offers low-cost health coverage for children from birth through age 18. CHIP is designed for families who earn too much money to qualify for Medicaid but cannot afford to buy private health coverage. This coverage comes through the Medicaid program, which is why they are frequently seen together.

Income Qualification for Medicare

A family of four with an income of $25,750.00 at the poverty level and eligible for Medicaid or CHIP coverage. For an individual the amount was $12,490.00. The amount goes up by $4,420.00 for each additional family member. “The guidelines change every year,” Goldstein said.

The Good News

There are plenty of alternatives available to individuals and families that can be used short or for the longer term that are not all based on a job with insurance. People under age 26, may even be able to join their parents’ employer-based plan. “There are places to go and affordable resources available,” Dr. Goldstein concluded. “Any type of healthcare insurance or coverage will help protect your finances later.”

About Houston Healthcare Initiative And Dr. Steven Goldstein

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.

 

How Will Healthcare Change After Coronavirus Covid-19

Rapid deployment to battle epidemics is key to winning.

How Will Healthcare Change After Coronavirus Covid-19

Doctors, hospitals, state and federal government agencies along with drug and insurance companies have all made concessions to the public during the time of the Coronavirus Covid-19 pandemic. This emergency affects every American so it stands to reason that what follows will too. But will common sense, red tape cutting, sensible changes that benefit patients remain, or be disposed of like so much medical waste? And what about preparations for future outbreaks? Houston based neurologist Dr. Steven Goldstein of the Houston Healthcare Initiative shares his views on this topic with his podcast audience. The podcast is available on iTunes, Soundcloud, Libsyn, and on www.houstonhealthcareinitiative.org.

Telemedicine

While remote access to doctors via Internet based communications is nothing new, it was never widely used until the outbreak of the Coronavirus/Covid-19 pandemic. But will patients continue to use this convenience? “It depends on what insurance companies will cover as well as what the regulations are from the state board of medical examiners,” Dr. Goldstein told his listeners. “There are plenty of good reasons to maintain this capability. Remote locations, lack of transportation resources and the reality that sick people are not keen to go to a clinic or doctor’s office whether they have the flu, a stomachache or even the Coronavirus should all help persuade the insurance industry to maintain payments for remote appointments.”

Lessons from the Pandemic – Rapid Strike Force

The speed that a viral outbreak is met with can prevent wider infection. Borrowing from an analogy coined by Bill Gates, Dr. Goldstein compared treatment to fighting a war.  “We need a standing army to spring into action when a virus is first found and ready to travel anywhere in the world to go to work,” he said.

LTC-Kryder-E-Van-Buskirk-Commander-of-the-8076th-MASH-in-Kunu-Ri-Korea-November-27
A medical rapid strike force to battle disease is one of the lessons the healthcare industry and government should apply after the Coronavirus/Covid-19 pandemic. LTC Kryder E. Van Buskirk, Commander of the 8076th MASH in Kunu- Ri, Korea, November 27, 1950. U.S. Army photograph 8A/FEC-50-22795 by CPL Fred A. Rice reprinted with permission.

Dr. Goldstein envisions teams of doctors, nurses, epidemiologists, virologists, and other medical professionals who can very quickly construct field hospitals on the site of the outbreak, isolate and treat the sick people and find treatments for them. “This would be like a ‘Mobile Army Surgical Hospital’ or MASH unit; fully equipped, staffed and right at the front line. The enemy is disease and must be fought aggressively.”

No Excuses

Goldstein thinks that the federal government must put a greater emphasis on public health and do more to keep people from getting sick. “This is not the first epidemic we’ve faced in recent years just the most recent,” Dr. Goldstein said. He described the many recent health crises the world has faced and faces including HIV/AIDS, Ebola, Zika, MERS and lately the Coronavirus/Covid-19 outbreak. “There will be no excuse for any lack of preparedness when this happens again, and we know it will happen again.”

About Dr. Steven Goldstein

The goal of Dr. Steven Goldstein and the Houston Healthcare Initiative is to be a catalyst for change in the way Americans receive and pay for medical treatment. To cause change his web site is an aggregator of information, tools, and targets for the reform of the healthcare industry with an emphasis on free market innovation and personal responsibility.

 

 

Follow-Up To Help Prevent the Spread of Coronavirus/Covid19 Patients Benefit From Telemedicine Appointments

Follow-Up To Help Prevent the Spread of Coronavirus/Covid19 Patients Benefit From Telemedicine Appointments

March 19, 2020 — Until a couple of weeks ago, the use of telemedicine was mostly for convenience. Now, it is a necessity as people work to keep their collective distances from each other. As announced previously, Houston neurologist Dr. Steven Goldstein will offer his diagnostic and medical skills via virtual or ‘telemedicine’ appointments for both new and existing patients.  “As long as Houstonians are suffering from the effects of the pandemic, I will waive copayments for those who have health insurance and significantly lower fees for those without insurance,” Dr. Goldstein said. With so many working hard to prevent the increase of the virus, using an existing technology without sacrificing access to himself or staff is a beneficial service.

Looser Rules Benefit Houstonians

On Friday March 13, 2020, when Gov. Greg Abbott declared a state of emergency, he made it possible for state agencies to use telemedicine. The Texas Medical Board also allowed for the medical community to use telemedicine, including the use of phone only, to see patients.

There are many benefits as so many people are staying away from public spaces during the Coronavirus/Covid19 outbreak. Here are a few of those advantages:

  • With telehealth services, patients avoid unnecessary office or hospital visits, hopefully lowering their risk for contracting or spreading Coronavirus/Covid19.
  • Through an emergency declaration under the Stafford Act and the National Emergencies Act, Medicare coverage will now include three types of virtual services: Medicare telehealth visits, virtual check-ins, and e-visits.
  • Virtual check-ins allow Medicare beneficiaries to communicate from their home with a provider.
  • Those who must rely on public transportation will not have to venture outside their homes to come in contact with other people and surfaces where the virus can remain for some time.

Medical Specialties

All of the medical news is about the spread or containment of Coronavirus/Covid19. But people will still need to be seen by specialists, including neurologists like Dr. Goldstein. For those with symptoms that suggest a neurologist, Dr. Goldstein is available. Some symptoms include:

  • severe headaches,
  • seizures,
  • numbness,
  • weakness,
  • double vision,
  • dizziness,
  • passing out,
  • tingling,
  • trouble with movement,
  • memory challenges or confusion,
  • and trouble sleeping.

How To Be Seen

To be seen by Dr. Goldstein via ‘telemedicine’ call his office and make an appointment, just like always;  give the patients’ email address and then go to the App Store and download Zoom Cloud Meeting. Zoom is free. Dr. Goldstein will email a link to the patient to use during the time of the appointment. Dr. Goldstein can diagnose, order tests, and prescribe medication via the Zoom link. To make an appointment call (713) 451-5421, or (281) 481-4236.

Zoom App Information

Zoom is available for Apple, Google Play and Windows. For all the ways to download and use Zoom go to their download page here: https://zoom.us/download.

Follow Dr. Goldstein from his Facebook page at: https://www.facebook.com/Houston-Healthcare-Initiative-192537484753616/?modal=admin_todo_tour. Or his website address: https://houstonhealthcareinitiative.org.

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To Help Prevent the Spread of Coronavirus/Covid19 Houston Neurologist Makes Telemedicine Appointments Available

Houston, TX. (March 19, 2020) – As a result of the Coronavirus/Covid19 outbreak and efforts to contain exposure, long time Houston neurologist Dr. Steven Goldstein will offer his diagnostic and medical skills via virtual or ‘telemedicine’ appointments for both new and existing patients.  As long as Houstonians are suffering from the effects of the pandemic, Dr. Goldstein will waive copayments for those who have health insurance and significantly lower fees for those without insurance. “With so many of us all working hard to prevent the increase of this virus, I wanted to leverage existing technology and keep access to myself and my staff available without putting any of us or our patients at unnecessary risk,” Dr. Goldstein said. “It seemed like a pretty good way to be of service here in the greater Houston area during such a challenging time.” Those who do not have insurance pay $75.00 for a first time visit and $35.00 for any needed follow-up visit.  Virtual office visits are conducted via the free Zoom Cloud Meeting app. Payments via debit or credit card are available through the office.

To Help Prevent the Spread of Coronavirus/Covid19 Houston Neurologist Makes Telemedicine Appointments Available

Telemedicine

The use of technology along with the reduced price makes Dr. Goldstein’s expertise available to people who cannot come to his office or afford to see a specialist like him or both. “Virtual medicine is nothing new, but it has not caught on like other remote services have,” Dr. Goldstein said. “This way of seeing patients now may be a turning point for the use of remote communications technology during this health crisis, with positive implications into the future.”

Treat Patients & Prevent the Spread of Coronavirus/Covid 19

The focus of the medical world now is on the prevention of Coronavirus/Covid 19. But there are plenty of people with symptoms a neurologist needs to diagnose and treat. Some symptoms include:

  • severe headaches,
  • seizures,
  • numbness,
  • weakness,
  • double vision,
  • dizziness,
  • passing out,
  • tingling,
  • trouble with movement,
  • memory challenges or confusion,
  • and trouble sleeping.

How To Be Seen

To be seen by Dr. Goldstein via ‘telemedicine’ call his office and make an appointment, just like always;  give the patients’ email address and then go to the App Store and download Zoom Cloud Meeting. Zoom is free. Dr. Goldstein will email a link to the patient to use during the time of the appointment. Dr. Goldstein can diagnose, order tests, and prescribe medication via the Zoom link. To make an appointment call (713) 451-5421, or (281) 481-4236.

Zoom App Information

Zoom is available for Apple, Google Play and Windows. For all the ways to download and use Zoom go to their download page here: https://zoom.us/download.

Follow Dr. Goldstein from his Facebook page at: https://www.facebook.com/Houston-Healthcare-Initiative-192537484753616/?modal=admin_todo_tour. Or his website address: https://houstonhealthcareinitiative.org.

 

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Houston Based Neurologist Explains Reason for ‘Surprise Hospital Bills’

A Houston based neurologist, Dr. Steven Goldstein, explains the reasons patients can get very expensive hospital bills even if they went to a hospital, clinic or emergency room that is part of their insurance network on his latest podcast. The Houston Healthcare Initiative podcast can be heard on Soundcloud, iTunes, Libsyn, or on www.houstonhealthcareinitiative.org

Houston Based Neurologist Explains Reason for ‘Surprise Hospital Bills’

No Insurance Network Required for Doctors

While the insurance industry has trained patients, doctors, and hospitals that we all must have insurance and be part of an insurance network the same is not the case for doctors. While in-network doctors and hospitals have agreed with the insurance company how much procedures and tests will cost, not all doctors who work in hospitals are part of any insurance network and can charge more than what insurance will cover. To make this worse for patients and the ultimate cause of ‘surprise hospital bills’ hospitals, emergency rooms or clinics are not required to disclose this to patients or their loved ones. As Dr. Goldstein told his listeners, “behind the scenes, the in-network doctor and the hospital agreed in advance what the charges were going to be. So, the in-network doctor is paid a flat rate based on that agreement. The doctor who works at the hospital but is not part of the insurance network can charge more and get paid more. He is under no obligation to say anything about this to the patient and will not.”

How Can This Be? Private Equity Companies

Private equity companies that own staffing firms and place doctors to work in hospitals along with the American Hospital Association have stated publicly that restricting the independent pricing capability will make putting doctors in geographic or socially challenging locations much more difficult, as higher pay is the biggest incentive for going to work in rural or economically disadvantaged areas. These doctors have no incentive to join an insurer network, which would require them to cut their fees. These are the source of many surprise medical bills.

Doctor Patient Unity Unmasked

A shadowy lobbying group known as Doctors and Patients United are owned and funded by TeamHealth and Envision Healthcare, private-equity-backed companies that own physician practices and staff emergency rooms around the country. In late July, 2019 Doctor Patient Unity placed more than $28 million  in ads opposing the legislation that would ban surprise medical bill, without disclosing who was behind the ads.

Current Information on Federal Legislation

There are several committees and bills on this being considered. At this writing the following bill was being considered: S 1895: Lower Health Care Costs Act. The bill was introduced by Senator Lamar Alexander (R, Tennessee) on June 19, 2019 and reported June 26, 2019. The committees assigned to this bill sent it to the House or Senate as a whole for consideration on June 26, 2019. For resources and the information to act on this bill please go to: https://www.govtrack.us/congress/bills/116/s1895.

Well-known and respected Houston based Neurologist Dr. Steven Goldstein is dedicated to reforming healthcare in the U.S. through education and information to the people who need it most. To learn more about the Houston Healthcare Initiative please go to www.houstonhealthcareinitiative.org.

Unexpected Emergency Room Bills Add To Patient Ills

Patients may go to the hospital designated as in network by their insurance, but the doctors who treat them may not be part of that network. This is one of the main reasons for big bills even among those who have health insurance. Patients rarely have any say about who treats them, especially in the case of accidents where they are incapacitated. This is the message that Dr. Steven Goldstein has for podcast listeners this week. The Houston Healthcare Initiative CO-OP podcast can be heard on Soundcloud, Google Play, and iTunes. The podcast and much more information is available from the Houston Healthcare Initiative CO-OP website: www.houstonhealthcareinitiative.org. Or click here to listen:


Unexpected Emergency Room Bills Add To Patient Ills

Wide Awake Nightmare

Imagine leaving the hospital after recovering from an accident, illness or some other unexpected and unwelcome ailment thinking that the worst is over, but then getting a walloping big bill to pay even with really good health insurance. It’s a scenario that plays out ever day and one that respected Houston based neurologist and founder of the Houston Healthcare Initiative CO-OP thinks the public has a right to know.

The out-of-network billing problem exists in part because insurers have sought to rein in costs by shrinking their provider networks and steering patients to less expensive doctors and hospitals. But some specialists and provider groups have deliberately stayed out-of-networks because they can make more money.“This is especially true in emergency rooms, where the patients’ inability to choose their doctors provides a strong incentive for physicians not to cut deals with insurers,” Dr. Goldstein said.  “For example, a 2017 study on surprise bills by Yale University researchers reported that one group of emergency room physicians that exited networks to bill as out-of-network providers charged twice as much for care as their ERs used to charge. It’s ridiculously unfair.”

Facts About Bad Surprises

Unwelcome E.R. and hospital bill surprises are not unusual and that is the disappointing part. On average, 16% of inpatient stays and 18% of emergency visits left a patient with at least one out-of-network charge. “Most of those came from doctors offering treatment at the hospital, even when the patients chose an in-network hospital, according to researchers from the Kaiser Family Foundation,” Dr. Goldstein told his audience. “But the news gets worse because the same study found that when a patient is admitted to the hospital from the emergency room, there’s a higher likelihood of an out-of-network charge. As many as 26% of admissions from the emergency room resulted in a surprise medical bill.”

Why We All Tolerate This

When asked about the reasons the public chooses to tolerate this, Dr. Goldstein replied, “the medical and insurance industries have trained us all to think that there is but one choice for us and that is to work with them, exclusively, and that there are no alternatives available for anyone not old enough to get Medicare.” There are alternatives, like the one we have at the Houston Healthcare Initiative CO-OP, but so few are aware of this and other similar organizations that we all simply take and pay for what is available.”

To learn more about the Houston Healthcare Initiative CO-OP please visit the web site atwww.houstonhealthcareinitiative.org