Wednesday, March 11, 2020

How about a national reporter hotline for Coronavirus balance billing?

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It's been a running joke on healthcare Twitter for some time that Americans' best defense against egregious surprise billing and relentless hospital debt collection is to call a reporter.

With Sarah Kliff (now at the NYT) crowd-sourcing outrageous emergency room bills at Vox and Kaiser Health News maintaining a Bill of the Month series, there's been saturation coverage of these practices that render health insurance effectively illusory for tens for millions of Americans.

With almost comic frequency, ERs caught out billing patients thousands for minimal work and hospital systems exposed for suing thousands of low income patients have forgiven bills or announced that they are changing their dunning practices after being exposed in the national press. For example....

Zuckerberg San Francisco General rolls back a $20,000 ER bill sent to an insured patient after a bicycle accident -- then reviews its practice of balance-billing every privately insured patient brought to its doors. A behemoth dialysis provider cancels a half-million dollar bill. A week after KHN's Jay Hancock reports that University of Virginia has sued 36,000 patients, garnished thousands of paychecks and put liens on homes, the hospital admits it was too aggressive and revamps its financial aid guidelines. Just today we learn that another predatory debt collector in Virginia, VCU Health, will stop garnishing wages and putting liens on people's houses.

Meanwhile, as Americans take the measure of the threat posed by the coronavirus, David Anderson reminds us that notwithstanding insurers' promises to waive cost-sharing for virus testing and treatment, both are likely to be subject to balance billing. Based on Health Care Cost Institute data, Anderson notes,
the most common specialty to have an OON bill is an independent lab. The second most common Emergency Medicine. COVID-19 requires a lot of testing.  Some people will be using lots of emergency services provided by EM docs. We should expect a significant amount of testing and ED services to be provided by OON providers.
The prevalence of balance billing is a public health hazard. Americans are hyper-aware of the practice. The Kaiser Family Foundation's latest tracking poll found that an astonishing 65% of Americans worry about receiving unexpected medical bills. A third of respondents report having received such bills in the past two years. Half of them say the unexpected bill was from an out-of-network provider. People are rightly afraid to go to the doctor or hospital or undergo a test sent to a lab.

Conversely, providers are increasingly aware that they may be shamed by intrepid reporters for predatory billing and collection practices. When Sarah Kliff started her ER bill crowdsourcing project in late 2017, the American Hospital Association warned its members.

In the current national emergency, perhaps the joke should no longer be a joke.  What if KHN, Vox, the New York Times and other news organizations were to pool their resources and set up a reporter hotline for those who get hit with large or unfair bills for Coronavirus testing and treatment?

For the present, KHN solicits unfair patient bills on the Bill of the Month web page. Sarah Kliff  posts contact info in her Twitter profile. Those who follow healthcare news can find an ear. But a hotline publicized by multiple news organization could constitute a really tangible, if desperate, form of fourth estate regulation.

Many hospitals and doctors are likely to be under enormous stress in coming months. Genuine tales of heroic commitment and endurance will rightly abound. But toxic billing machinery and reflexive revenue maximization is unfortunately hard-wired throughout our healthcare system.  Deterrents to bad behavior will benefit the providers as well as the public.

Update: The City newspaper in New York has a tale of a NYC teacher with developed Coronavirus-like symptoms after a visit to Italy, went to NYU Langone on March 2 hoping for a Coronavirus test, sat for six hours, got an x-ray and no test -- and a bill that broke out over $10,000 in billed charges, a payment of just under $3,000 from her insurer, and a $75 copay for herself. Not a balance billing horror story -- just the routine insanity of U.S. billing and payment that highlights the space in which balance billing flourishes.

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