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 the Houston Healthcare Initiative website.
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 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 bills, 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 (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.
Dr. Goldstein is dedicated to reforming healthcare in the U.S. through education and information to the people who need it most.