Wednesday, May 20, 2015

Your money or your life

Last September, the Times' Elisabeth Rosenthal spotlighted the manifold ways in which hospitals impose out-of-network billing charges on patients even when the patients have contracted with an in-network physician in an in-network hospital.

Rosenthal documented how hospital ORs and EDs operate as free-billing zones in which an array of doctors, physical therapists and other service providers can insinuate themselves in a procedure without the patient's prior knowledge or consent, whether they're in the patient's insurance network or not -- and then relentlessly pursue either the insurer or the patient or both for their exorbitant billings.

She's made me extremely wary to enter a hospital for any purpose  -- a reluctance that I suppose could in itself be dangerous to my health (or, conversely, salubrious; see point 3 here). But I had evidence today that the virus, so to speak, has spread to physician practices, which hospitals are relentlessly buying up and contracting with. In my primary care physician's office, I was confronted with a form requiring me, theoretically at least, to put all I own in hoc to the parent parent company, a certain Atlantic Health System:
I understand the Hospital charges do not include the fees of my treating physician, or the fees for services provided by Emergency Department physicians, anesthesiologists, cardiologists, neonatologists, obstetricians, pathologist, radiologists, surgeons, the on call physician, other consultants, and other Voluntary Medical Staff  who may treat men. I understand that I am financially responsible for the payment of my physician fees and these fees may not be covered by my insurance plan.
You can't be much plainer than that. Anyone within the confines of any of our facilities can do whatever they want to you and bill whatever they want, and you agree to pay it.

New York just passed a law, effective March 31, that provides substantial though not bullet-proof protection from this predation.  It does not apply fully to self-insured plans, however. Protection should be national, and uniform, and comprehensive.


  1. Good for you. I once tried not to sign a 'pledge' like the one you cite when my wife gave birth. The medical staff gave me and her dirty looks throughout.

    Hell, Obama was a lawyer. I wish he had gone after the bad laws in health care with the same attention to detail as was given health insurance. See my website for a more detailed expostion of what we need.

  2. This is one of the reasons why the health sector and policies should be revised in an articulate manner to safeguard unsuspecting people who may incur additional charges as a result of this extra billing by the hospitals. This avoids misunderstandings with the insurance. My wife almost underwent through the same ordeal with an eye specialist.

    Derek Walsh @ Simply Insure