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naraburns  nihil supernum  1yr ago (text post)   3367 thread views

Small-Scale Question Sunday for January 1, 2023

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It was insurance, apparently the hospital is in network but the physicians assistant was not so they won’t pay any of it. Also the physicians bill didn’t come from the hospital but from some other entity which refused to negotiate.

I've had this happen. The last town we lived in, the entire ER staff was out-of-network! Do you know if your state has a law against surprise billing? I am really happy that I now live someplace that does.

Surprise billing legislation (while superficially well meaning seeming) is a scam invented by insurance companies as a negotiating tactic, which is part of why its implementation is limited.

Can you point me to any support for this statement, or why this legislation would be undesirable for consumers?

https://old.reddit.com/r/medicine/comments/da5ccm/in_california_a_surprise_billing_law_is/

In general you can dig around on meddit just search for surprise billing.

Superficially this looks more like a problem for docs than for patients (well fuck you guys just take a pay cut) but in general you want doctors to have more leverage and control because while they want money (just like anyone else) they came into the field despite the opportunity costs because they wanted to actually help people. The other interests are just trying to extract value for the least costs (insurance companies, private equity firms that buy physician groups and so on).

Physician power and influence (and self-employment) has been plummeting for awhile now and they essentially minimal influence over care and costs in a lot of settings which generates the stuff that pisses people off.

A doc can provide free care (and many did) if they aren't owned (by a hospital, practice management group etc).

Shorter version: monopolistic competition = bad.

I agree that monopolistic competition is bad, which is why it's terrible that I can have one hospital in my city and their ER doesn't take insurance. What is the average person supposed to do in that situation? They can't shop around; they just have to eat whatever medical bill comes their way, on top of whatever they and their employer pay for insurance.

Emergency medicine is a place where the free market system really breaks down, and we need a different solution from what we have now. I don't know if the surprise billing legislation is the best situation, but what else is being proposed?

Why can't the insurer pay the customer directly?

Surprise billing pops up in two major places- the ED and for consult/pop-in needs.

The later is rarer, less obvious to patients, and harder to fix without big sweeping reform (I NEED EXTRA HANDS IN THIS ROOM RIGHT NOW or "is anyone at work right now who can help answer this question?" are hard problems) attempts at fixing the ED stuff break this process to and discourages those resources from being available. Nobody wants to risk not getting paid so community hospitals have an increasing dearth of specialists and then whole death spiral (for the health system) and poor quality of care things happens.

The issue with the ED is that the structure of American healthcare discourages physician self employment and physician owned practices, so one of the major driving factors here is that private equity groups have bought all of the ED doctors who aren't hospital owned and then start some fuckery with the insurance companies and this is one of the things that shakes out.

Realistically it's still a problem in physician lead healthcare but right now it's those large and connected industries fucking with each other.

Some breakthrough protection would probably help a lot "in case of truly emergent care needs the professional fees need to be covered by insurance but at no more than 110% of the fee schedule for the mean costs of in network professional fees" or something would fix the problem.

I'm sure that would have issues but the point is that the insurance companies aren't interested in fixing the problem they are interested in lobbying so that they don't need to pay for things and someone else gets the blame.

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