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Out of Network Billing

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  • pulmdoc
    replied
    Yep, hence the proposed legislation to stop them.

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  • CM
    replied




    Physicians are not obligated to accept insurance plans for reimbursement, however they are out of network so patients are disincentivized to see them. There has been a flurry of news articles about huge surprise bills from “behind the scenes” doctors (anesthesia, path, etc) where the patient thought they did everything right to be in network but a doctor they had no control over choosing generated a huge out of network bill. One egregious example that sticks in my mind was an article about a patient who had back surgery, something straightforward like a 2 level neck fusion. The primary surgeon bill was something like 1k. The surgeon’s partner scrubbed in as first assist and billed 100k out of network which the patient was on the hook for. Investigation showed that the first assist surgeon refused all insurance and did first assist on all non-governmental patients (Medicare caps first assist to I think 15% of primary surgeon bill) to generate these humongous bills. Another example shared by one of my own patients was that his back surgery cost 3k, but the intraoperative neuro monitoring doc (who has a tech in the room and just reviews the tracings later) charged 25k because out of network. I think it’s hard to generate sympathy from the public based on these cases.
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    These are muggings.

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  • pulmdoc
    replied
    Physicians are not obligated to accept insurance plans for reimbursement, however they are out of network so patients are disincentivized to see them. There has been a flurry of news articles about huge surprise bills from "behind the scenes" doctors (anesthesia, path, etc) where the patient thought they did everything right to be in network but a doctor they had no control over choosing generated a huge out of network bill. One egregious example that sticks in my mind was an article about a patient who had back surgery, something straightforward like a 2 level neck fusion. The primary surgeon bill was something like 1k. The surgeon's partner scrubbed in as first assist and billed 100k out of network which the patient was on the hook for. Investigation showed that the first assist surgeon refused all insurance and did first assist on all non-governmental patients (Medicare caps first assist to I think 15% of primary surgeon bill) to generate these humongous bills. Another example shared by one of my own patients was that his back surgery cost 3k, but the intraoperative neuro monitoring doc (who has a tech in the room and just reviews the tracings later) charged 25k because out of network. I think it's hard to generate sympathy from the public based on these cases.

    Leave a comment:


  • Antares
    replied
    All my billing is out of network, so no change for me.

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  • VagabondMD
    Radiologist (retired)

  • VagabondMD
    replied
    I think that for our radiology group, this is a non-issue. We are contracted with all of the major payers in our area and rarely get compensated on billed charges.

     

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  • CM
    replied




    Checking in to see if any docs in the White Coat Forum are planning on a decrease in income when the feds/state disallow out of network billing for all specialties. White Coat’s advice on keeping expenses low is CRITICAL to your bottom line as this issue gets sorted out in the state capitals and at the federal level.  Private groups across hospital and non hospital based specialties are selling out to CMGs rapidly. EM(my field), Anesthesia, Path, Rads, Cards, Surgery, IM, Hospitalists all in the cross hairs now. Interested to hear how docs across specialties dealing with issue in their practice. How do you plan to make up the lost income? State imposed caps looking ugly with rates slapped down to low multiples of medicare.

    White Coat–this may be a good poll topic as I see Utah is in the cross hairs now. Insurance companies have successfully changed their ‘surprise coverage’ into ‘surprise  bills.”  Most legislators think fair payment is medicare rates and anything more like Fair Health is too complicated. Most docs(private, employed, academic…) do not even realize this freight train is coming at them if they are not running the business end of the practice.

    CB

     

     

     
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    I'm one of the employed physicians unaware of the freight train. Can you provide more explanation/context?

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  • CB
    started a topic Out of Network Billing

    Out of Network Billing

    Checking in to see if any docs in the White Coat Forum are planning on a decrease in income when the feds/state disallow out of network billing for all specialties. White Coat's advice on keeping expenses low is CRITICAL to your bottom line as this issue gets sorted out in the state capitals and at the federal level.  Private groups across hospital and non hospital based specialties are selling out to CMGs rapidly. EM(my field), Anesthesia, Path, Rads, Cards, Surgery, IM, Hospitalists all in the cross hairs now. Interested to hear how docs across specialties dealing with issue in their practice. How do you plan to make up the lost income? State imposed caps looking ugly with rates slapped down to low multiples of medicare.

    White Coat--this may be a good poll topic as I see Utah is in the cross hairs now. Insurance companies have successfully changed their 'surprise coverage' into 'surprise  bills."  Most legislators think fair payment is medicare rates and anything more like Fair Health is too complicated. Most docs(private, employed, academic...) do not even realize this freight train is coming at them if they are not running the business end of the practice.

    CB

     

     

     
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