Friday, November 06, 2015

Hospitals expect you to price shop before you give birth. Good luck with that.

Sarah Kliff wrote on Vox Hospitals expect you to price shop before you give birth. Good luck with that.

The two women are co-workers with the same insurance plan. By coincidence, they happened to become pregnant around the same time and gave birth at the same hospital. They both selected in-network obstetricians to deliver their babies. Both chose to receive an epidural from an anesthesiologist as they gave birth — and that’s where things began to diverge. Here’s more from their co-authored blog post at Health Affairs:

Layla received an unexpected bill for $1,600 for anesthesiology services and warned Erin to expect the same. Yet Erin’s bill never came. Layla happened to deliver on a day when an out-of-network anesthesiologist was on call, while Erin was seen by an in-network anesthesiologist. Purely by chance, one of us received an expensive physician bill and the other did not have to pay a dime.

The two later figure out what happened: While the hospital they chose was in-network for the health insurance plan, Layla’s anesthesiologist was an out-of-network provider. Just because he worked at the hospital, that didn’t guarantee that he was one of the doctors that the insurer had in contract."

It’s the obvious problem of treating healthcare like a market, you can’t always shop around (even if you did have enough information to compare providers or treatments). The out-of-network doctor at an in-network hospital hadn’t occurred to me. She also pointed to this NY Times story, After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know.

In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees. They may be called in when the need for them is questionable. And patients usually do not realize they have been involved or are charging until the bill arrives.

Obviously you want doctors to help each other when needed, but there has to be a more rational way to compensate them. Particularly when in and out of network fees are so staggeringly different:

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digby displays the requisite outrage:

If a person is in their network approved hospital they should not be charged for services by people who have not contracted with that hospital. Period. This should be something that the insurance companies battle out with the hospitals not something about which an individual should even be aware. You follow the rules and go to your designated facility that should be the end of your responsibility. How it isn’t already is just mind-boggling.

The hoops you have to go through if you’re travelling or if you’re taken to a hospital out of network are already ridiculous. Emergencies should be paid by insurance without question wherever we are in the country. But this takes it to a whole new level. You’re in an emergency medical situation and you’re expected to inquire as to whether your doctors are in your network? And what if they aren’t? Are you expected to stop treatment until they offer you someone who is? It’s crazy.

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