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It's Not Just Hospitals That Are Quick To Sue Patients Who Can't Pay

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  • It's Not Just Hospitals That Are Quick To Sue Patients Who Can't Pay

    Saw this on NPR... interesting article.

    https://www.npr.org/sections/health-...s-who-cant-pay

    TLDR version: private equity Blackstone acquires TeamHealth (one of the two dominant ER staffing firms), there was an increase in patients who couldn't pay being sued (which can result in court-ordered judgment to garnish the patient's wages), TeamHealth ultimately pledged to stop suing patients and to offer generous discounts to uninsured patients

    As private equity continues to buy more physician practices (Feb 18th 2020 JAMA article), I wonder about the long-term ramifications. I've heard discussed before the impact of private equity on docs (less autonomy and control), but this affect on patients puts a new spin on things


    The firm that staffed the emergency room with doctors at Nashville General Hospital was taking more patients to court for unpaid medical bills than any other hospital or practice in the city.

  • #2
    I have discretion to send patients to collections, and next step would be taking them to court. I send all my patients to collections for any amount they owe. Granted I don’t take any to court because I’d have to put up money and probably wouldn’t get any but if patients aren’t paying their bills then what do you propose?


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    • #3
      I am the first to say that our healthcare system is broken and that billing can be ridiculous. But at least daily, I see a patient who "couldn't afford to see my doctor, so I came to the ER"...the magical land where nothing costs anything and everyone works for free.

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      • #4
        There should be a rule against billing uninsured patients more then a physician would accept in medicare/medicaid reimbursement. If a physician is willing to accept x amount doing work for medicare/medicaid, why should he/she expect an uninsured patient to pay some multiple of that. That being said, I feel like it probably would be good if they held patients more financially liable for ER visits. It does help dissuade unnecessary visits. Maybe make some sort of option where people can have their copay waived if the patient reasonably thought that they were dealing with an emergency (ie certain symptoms) or if they are admitted.

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        • #5
          Almost any place I've ever been will gladly give up to a 50% discount for uninsured if they pay their bills on time. I find this is rarely you spy typical populations however when I was in Pennsylvania it was very common among the Amish communities. They were very happy to take the discount and they always paid their bills. But they would argue about any test you asked them to do to make sure it was absolutely necessary. I feel it actually made us much better doctors having to explain the importance of each test even if it was rather cumbersome and annoying.

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          • #6
            This is perfectly timed for pending balance billing legislation.

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            • #7
              Originally posted by nephron View Post
              There should be a rule against billing uninsured patients more then a physician would accept in medicare/medicaid reimbursement. If a physician is willing to accept x amount doing work for medicare/medicaid, why should he/she expect an uninsured patient to pay some multiple of that. That being said, I feel like it probably would be good if they held patients more financially liable for ER visits. It does help dissuade unnecessary visits. Maybe make some sort of option where people can have their copay waived if the patient reasonably thought that they were dealing with an emergency (ie certain symptoms) or if they are admitted.
              So then what’s the incentive to pay for insurance? If you’re going to pay less than commercial insurance rates (since Medicare/Medicaid pay less than commercial insurances), why bother paying insurance premiums at all?


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              • #8
                I do not have any solutions for the healthcare economic problems. But I will say ERs are absolutely abused because the ER is "free" but a doctor isn't. It is terrible medicine & a waste of resources.
                $1 saved = >$1 earned. ✓

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                • #9
                  The question becomes, should patient #2 pay for #1 and #3 that have no money? I sure would not appreciate paying the tab in a restaurant for two tables I didn’t know. A free lunch isn’t free.
                  Don’t kid yourself, ER services are being abused in many cases.

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                  • #10
                    I suggest reading Dr. Makary’s The Price We Pay. The beginning of the book goes over research they did in this matter of suing patients. It wasn’t a private equity issue. Non-profits were some of the worst offenders.

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                    • #11
                      Originally posted by Cubicle View Post
                      I do not have any solutions for the healthcare economic problems. But I will say ERs are absolutely abused because the ER is "free" but a doctor isn't. It is terrible medicine & a waste of resources.
                      maybe more people would come to see me in the office if I was willing to give them a shot of Dilaudid when they came in with acute pain.

                      All joking aside some people have a really hard time getting into their primary doctor's office. I'm not sure why people make it so difficult. I try to be incredibly accommodating and get anybody in almost anytime. but even still people don't even call us and go straight to the emergency room and there's nothing we can do about that.

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                      • #12
                        Originally posted by MaxPower View Post

                        So then what’s the incentive to pay for insurance? If you’re going to pay less than commercial insurance rates (since Medicare/Medicaid pay less than commercial insurances), why bother paying insurance premiums at all?

                        I used to have the same view but I recently looked at the payments for visit codes from the common commercial insurers. Most like UHC, Aetna and Cigna paid not much more than Medicare and Humana and Blue Cross paid significantly worse than Medicare.

                        I charge Medicare rates for uninsured or for things that then commercial insurer does not want to pay but patients want. I get the cash, don't have to worry about sending to collections or suing them. And they are happy and quite loyal patients.

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                        • #13
                          We just got a $1.06 bill from our child's PCP for a vaccine that wasn't fully covered.
                          We want to pay in pennies.
                          The bill arrived 8 months after the visit. I can only imagine the fight between the PCP and insurer.
                          When you think of the price of a stamp they aren't getting much 'profit' from sending this bill.

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                          • #14
                            Originally posted by nephron View Post
                            There should be a rule against billing uninsured patients more then a physician would accept in medicare/medicaid reimbursement. If a physician is willing to accept x amount doing work for medicare/medicaid, why should he/she expect an uninsured patient to pay some multiple of that.
                            No, there shouldn't. This is fairly dangerous. I don't know why insurance companies wouldn't just go out of network with everyone to get medicare pricing.

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                            • #15
                              Originally posted by ITEngineer View Post
                              We just got a $1.06 bill from our child's PCP for a vaccine that wasn't fully covered.
                              We want to pay in pennies.
                              The bill arrived 8 months after the visit. I can only imagine the fight between the PCP and insurer.
                              When you think of the price of a stamp they aren't getting much 'profit' from sending this bill.
                              Your child’s PCP needs every last penny they can get.

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