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The root cause of the problem. People don’t get to choose their physicians in certain specialties: ER, anesthesia, radiology, pathology. So these specialties have remained out of network and have charged patients many times what Medicare would have paid for their services. This is especially true of private equity-funded groups that have remained out of network as an economic strategy. Don’t cry for these docs. Their incomes have exploded.
The no-surprise act simply requires that, when their demands are excessive (billing, say, 5-10 times what Medicare would pay for a service) that they have to justify these prices to a third party.
David, you clearly have no clue how reimbursement for physicians and Medicare works. For instance with anesthesiology, Medicare rates are approximately 1/3 of our negotiated rates with lowball insurers like Anthem. So if we accepted Medicare rates for every patient that walked in the door you would see an exodus of anesthesiologists.
Doctors aren’t upset at patients with these new laws, they’re just upset with insurance companies literally dictating reimbursement at all levels in the heath care system and how they continue to decrease it every single year rather than giving inflationary increases over the years.
Glen, I actually do understand reimbursement. You’re note suggests that your “lowball” minimum is about 3 times what Medicare pays for anesthesia but you feel entitled to so much more. I think you’ve identified why the law was necessary.
David, why don’t you do some googling on how anesthesiology as a specialty does not function like other specialties when it comes to Medicare reimbursement. Maybe it will give you a more educated response. Saying that somebody pays you multiples of pennies on the dollar doesn’t mean it’s a lot of money; That’s the point you seem to be missing.
Glen, The average anesthesiologist salary in Indiana is $400,900. (salary.com)
Our system is plenty screwed up, and I’m no fan of the giant insurance companies sucking dollars out of what should be a non-for-profit endeavor, but the ER docs don’t engender much sympathy when they or their representatives say “We’ve struggled over the years”; and “These emergency physicians of all sorts are victimized”.
I am doubting that you actually work in an ED. The type of nonsense that comes in these facilities such as people with a head cold or a hangnail when they could’ve gone to a primary doctor is just the beginning of the discussion. Most of these patients are often Medicaid or no pay patients so yes, hospitals have to upcharge paying patients to subsidize the ones that don’t pay anything. If they didn’t do this then you wouldn’t have an ED to go to when you have a legitimate problem.
Glen, I never said I work in an ER. The rest of your comment is pretty much common knowledge and doesn’t touch on my comment. FWIW, I was an auditor at a Big 4 with a major hospital as a client for a few years. I am well aware of the payer mix issues.
There needs to be a penalty clause when insurers lose at arbitration. Currently, it’s a rigged game. The insurer chooses not to pay reasonable rates to ER docs. The ER docs have to pay admin and legal costs to try to get what they should be entitled to–which raises costs. The insurer usually has some sort of arbitration clause (certainly for the contracted physicians–but they often arbitrate even out-of-network disputes because it’s a faster process than litigation). The insurer keeps the $$ during the entire process. Most doctors don’t fight the insurers. So, the insurers “win” by being obstinant.
The accountants at Ford determined it was more cost-efficient to let Americans die than fix their gas tanks. What they did not count on was punitive damages. Here, Congress needs to institute some sort of punitive damages.
[That said, likely won’t happen. Insurers advertise a TON to support the advertising media. That media protects the government. The government pays for the industrial education establishment. The education establishment refreshes the ranks of media, insurance, and government workers, who depend on the insurers. Meanwhile, our front line healthcare workers and small business owners continue to get jobbed.]
BooHoo