Ahhh - Someone finally caught a provider doing what I've been bitching about.
Blatant disregard for all things moral....
Quote:
Aetna Inc. is suing six New Jersey doctors over medical bills it calls “unconscionable,” including $56,980 for a bedside consultation and $59,490 for an ultrasound that typically costs $74.
The lawsuits could help determine what pricing limits insurers can impose on ”out-of-network” physicians who don’t have contracts with health plans that spell out how much a service or procedure can cost.
One defendant billed $30,000 for a Caesarean birth, and another raised his fee for seeing a critically ill patient in a hospital to $9,000 in 2008 from $500 the year before, the insurer alleges in the suits. The Caesarean price was more than 10 times the in-network amount Aetna quotes on its website.
“If these charges are accurate, consumers and purchasers should be outraged,” said David Lansky, president of the San Francisco-based Pacific Business Group on Health, a coalition of health-insurance buyers that includes Chevron Corp., Walt Disney Co. and General Electric Co.
Lawyers for the doctors declined to comment on specific charges in the suits, and said their clients did nothing wrong.
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These are extreme cases of what I have personally experienced. It is so easy to blame the insurance companies, no I am not defending them, BUT there is a lot more blame to go around when they are being asked to pay for treatments, services or supplies that are marked up 1000% or much much more.
Addressing the cost component is an integral component where I believe the new law has fallen far short.
Quote:
The insurance industry is grappling with how to respond to out-of-network hospital physicians who realize they have pricing muscle, according to Arthur Leibowitz, chief medical officer of Health Advocate Inc., a Plymouth Meeting, Pennsylvania, insurance adviser.
“These doctors can charge whatever they want,” Leibowitz said. “The challenge for the carriers is to come up with an agreeable, acceptable, unbiased judgment as to what a reasonable and customary reimbursement rate is.”
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Does anyone know how this is impacted by the new HCRA? I have read as much as time permits and still cannot understand definitively the answer.
Going forward, what happens if more Docs drop out of networks and start billing whatever they feel is reasonable? That coupled with the infux of millions of new patients could be disastrous for the ever elusive cost-saving part of this law. I don't even want to think of adding those young healthy people who will opt out of coverage, which is certain to happen. In what numbers, no one knows.