Shopping for medical care
by digby
Gosh, this seems as if it might be something worth changing, via Vox's Sarah Cliff:
[T]wo 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.
"Who would have the presence of mind during labor to ask whether the anesthesiologist on call is part of her insurance network?" Taylor and Parast write in their blog post. "While providing patients with information regarding which physicians are in network is an important part of health insurance transparency, it is meaningless in situations where the patient has no choice."
The New York Times featured a horror story about someone who was insured but billed over a hundred thousand dollars after emergency surgery for an anesthesiologist who wasn't "in network." In fact, the Times piece indicated that this could be a scam where some doctors who were in network split the fees with those outside it.
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.
.