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:
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
