General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsTucked into the relief bill: A BAN on most "surprise medical bills."
It took many years, blocked by above all Republicans serving special interests, but it's happening!
Surprise bills happen when an out-of-network provider is unexpectedly involved in a patients care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesnt. Such doctors often bill those patients for large fees, far higher than what health plans typically pay.
Language included in the $900 billion spending deal reached Sunday night and headed for final passage on Monday will make those bills illegal. Instead of charging patients, health providers will now have to work with insurers to settle on a fair price. The new changes will take effect in 2022, and will apply to doctors, hospitals and air ambulances, though not ground ambulances.
Academic researchers have found that millions of Americans receive these types of surprise bills each year, with as many as one in five emergency room visits resulting in such a charge. The bills most commonly come from health providers that patients are not able to select, such as emergency room physicians, anesthesiologists and ambulances. The average surprise charge for an emergency room visit is just above $600, but patients have received bills larger than $100,000 from out-of-network providers they did not select.
Some private-equity firms have turned this kind of billing into a robust business model, buying emergency room doctor groups and moving the providers out of network so they could bill larger fees.
Among the major consumer problems in the fiendishly complex health system, surprise billing was the rare Washington issue that both parties could get behind. Health committee leaders have been engaged on the issue for years, as has the White House. President-elect Joe Biden included the proposal in his campaign health care agenda. It had the backing of many prominent and powerful legislators, including Senator Lamar Alexander, Republican of Tennessee and the retiring chairman of the Senate health committee. A survey published Friday by the Kaiser Family Foundation found that 80 percent of adults want the practice banned. More than a dozen states, including Texas and California, have passed bans of their own on surprise billing.
https://www.nytimes.com/2020/12/20/upshot/surprise-medical-bills-congress-ban.html

theaocp
(4,366 posts)Ran a search on the article and couldn't find anything about him. I wonder why he gave in.
TheRickles
(2,564 posts)He got into some hot water in his primary this Summer, and although he maintained plausible deniability, it looked like his campaign team smeared his opponent, the gay mayor of the second biggest town in his district. It was very well covered by The Intercept, in contrast to the Boston Globe: https://theintercept.com/2020/09/02/alex-morse-primary-result-richard-neal/
Alpeduez21
(1,895 posts)Universal coverage needs to happen. Too bad only the 'crazy lefties' are for it instead of decent people everywhere.
Hortensis
(58,785 posts)Think of all the people who'd have universal coverage by now, and all who would NOT have been devastated by uncovered medical costs over the past 4 years, if more people had, you know, voted to make it happen.
Democrat: UHC. No Democrat: No UHC.
So now we get what we can while we work toward getting it all.
And itm, let's be glad for those this will save from painful, and potentially dreadful, "surprise" costs. It's not just an ideological position for the many hit with this.
KPN
(16,342 posts)was the difference between having UHC and not. We didnt win the Senate in 2016 or the House.
Hortensis
(58,785 posts)The senate question was just how large a majority we'd get, not that it would happen.
The house had been considered impossible until the second year when it became possible. At very least the Republican majority would have become much smaller.
I will never forgive the hypocrites and scoundrels on the left who sabotaged that election while claiming to support UHC. If karma were even half real, they'd wake up each day afraid of what it might bring.
KPN
(16,342 posts)to have huge coattails as well.
Hortensis
(58,785 posts)agitpropists double-teaming with the same messages from the Republicans for the same purpose.
Funny how they think electing Republicans works better for them than electing Democrats.
Just what IS their agenda? Because it sure isn't getting universal healthcare to America.
NutmegYankee
(16,378 posts)One thing I love is the state law also forces in-network fees for emergency services at an out of network facility. So if Im in an accident and taken to random hospital not in network, I still get the lower copayment.
kairos12
(13,365 posts)dalton99a
(86,158 posts)If you have a medical emergency, go to a hospital ER.
If you need urgent care, go to urgent care like CVS.
Avoid "Emergency Rooms" that are not attached to a real hospital.
moreland01
(835 posts)to know off the top of your head which Urgent Care, Emergency Rooms and Hospitals your plan covers. Trying to find out when you're experiencing an emergency is way too late.
What I'm not so sure about is what happens if I call 911 and an ambulance shows up? Will my insurance cover me regardless of who shows up? I need to look in to that.
IronLionZion
(47,440 posts)because you will get destroyed if it's out of your network. Knowing ahead of time is good advice. Also have your insurance card with you at all times so you can call them if traveling or whatever.
A lot of people look down on me for having HMO instead of PPO, but as long as I can get to my HMO's facility, everything they do to me will be in network.
Medicare for all would be simpler, as we wouldn't have to worry about networks.
Politicub
(12,309 posts)he went to for a kidney stone, to the nearest Kaiser hospital.
Kaiser is great if youre in Northern California (maybe Southern, too). Its offered here in Atlanta on the ACA exchange and Medicare advantage, but there are few facilities. People seem to really like it once they get used to its system.
IronLionZion
(47,440 posts)but there are many who don't trust it.
dalton99a
(86,158 posts)wryter2000
(47,677 posts)Kaiser, Northern California, got into trouble for opening an emergency department without a hospital attached. It had nothing to do with fees. It did have to do with deaths caused because a few people needed to be hospitalized immediately but had to be transported to another Kaiser to get care. The consultants who suggested the plan were eventually given the heave-ho.
So, I would guess a free-standing ED can also be unsafe.
BTW, I have Kaiser, and I love it. The sort of crap in the OP would never happen at a Kaiser in California.
Dem4Life1102
(3,974 posts)When I complained about it, the provider canceled their bill.
intheflow
(29,280 posts)Every time my doctor's office makes an appointment for me, they tell me they're setting it up with someone in-house. No. The office is part of the plan, I pay $25 copay to walk in the door and sit in their waiting room until the doctor can see me. Two weeks later - outrageous bills. When I complain, they tell me their paperwork says the office is "in network." SO infuriating! This is a blessing!
bucolic_frolic
(48,483 posts)Doctors will soak them for every nickel they can get, and no one to deem their procedures unnecessary
Hortensis
(58,785 posts)And which conservative party and big business allies have always fought it?
It's really simple:
DEMOCRATIC MAJORITIES = UHC.
NO DEMOCRATIC MAJORITY = NO UHC.
It's SO simple, and so proven many times over, that anyone who denies that is either a lying scoundrel, an eager fool for lying scoundrels, or mentally whacked. Or some combination, as we see too often.
bucolic_frolic
(48,483 posts)the doctor treating you.
I once got a "political lecture" from a doctor. My allergies were caused by trees, in full alignment with Reagan.
After that we always knew only Republicans got real medicine in that town.
Hortensis
(58,785 posts)because you don't like doctors and doctor bills.
Okay. Another approach:
A. For those who really want UHC: Vote Democrat. There is no other way.
B. For those whose biggest agenda is screwing Democrats and who thus oppose any Democratic Party successes, as in healthcare: Don't vote Democrat.
Doctors aren't even in it. Just the vote, up or down, or none.
HuskyOffset
(912 posts)soryang
(3,308 posts)a deferred "ban."
keithbvadu2
(40,915 posts)Fullduplexxx
(8,424 posts)Loki Liesmith
(4,602 posts)FailureToCommunicate
(14,382 posts)
Fullduplexxx
(8,424 posts)So only a certain type of person would think that way. I completely agree ... crazy du spirit
Hortensis
(58,785 posts)hope and plan to this term. Our big dreams are not deferred to after the NEXT election until after the Jan 5 GA senate elections. There's still hope we'll be able to do it this time.
A bit of conviction would help, though. When people are weak and defeatist, the opposition always knows and uses them.
JohnnyRingo
(19,606 posts)I help make more Mercedes payments than a Kardashian.
PatrickforO
(15,160 posts)Sure would be nice if we had Medicare for all Americans, though.
Hortensis
(58,785 posts)Does it matter what the title of the program is as long as it's affordable UHC?
I aged out of waiting for the public option, which is NOT-for-profit I'd planned to choose as soon as it was added to the ACA, but I'm still waiting anyway:
Democrats will take aggressive action to ensure that Americans do not pay more for prescription drugs than people in other advanced economies, and ensure that all necessary medications are covered. We will empower Medicare to at last be able to negotiate prescription drug prices for all public and private purchasersfor families and businesses, as well as older Americansno matter where they get their coverage. We will also prevent the price of brand-name and outlier generic drugs from rising faster than the inflation rate. We will cap out-of-pocket drug costs for seniors, and ensure that effective treatments for chronic health conditions are available at little or no cost.
Unfortunately, right now the plan is to expand dental and eye care to Medicare recipients only, asap. Adding those coverages for all is another step. Should have been already, but in 2016 the people spoke...
If anyone knows someone in GA, ask him or her to please vote to make it all possible ASAP.

TXPaganBanker
(210 posts)Last year when I had double renal failure, the ER urologist that treated me was out-of-network. It was even more surprising because I was originally told he was, until the insurance denied it (I was in double kidney failure, the ER was the only option, and they had to perform emergency surgery). I'm praying that this is more comprehensive than ours, with little or no room for games in billing.
onecaliberal
(36,594 posts)Even with insurance, you are one catastrophic health event away from financial ruin.
Hortensis
(58,785 posts)down to $50,000. Huge money for us at any point, in those days half the value of the home we'd purchased over the previous 25 years. We took out a mortgage to pay for it and were able to stay in our home.
Not financial ruin, but it damaged us severely and permanently. We paid that mortgage for another 20 years by diverting money we'd been investing each paycheck to live on now.
We should have fixed this permanently four years ago when we could have. Only some of those who've been and will be ruined since did it to themselves and earned whatever they chose for others.
onecaliberal
(36,594 posts)My husband is permanently disabled, so on top of that bill we lost a 6 figure salary.
We have struggled since.
bucolic_frolic
(48,483 posts)I doubt that was targeted at COVID. It was more about general corporate liability and class actions. I say that because I think it would be quite difficult to link responsibility to the workplace, or to specific people in the workplace, or really outside the workplace. You could do it statistically, but that is not causality. Even contact tracing relies on testimony of the participants, who may or may not remember, lie, or be reluctant.
ehrnst
(32,640 posts)I went back and forth for months, and finally it was paid by insurance because the person operating it was in network...
OMGWTF
(4,550 posts)mn9driver
(4,639 posts)It took another year and hours on the phone to get it worked out. The US health care/insurance system is completely broken.
This bill is a small move in the right direction, which is a nice change, but way too little to actually fix the larger problem.
rdking647
(5,113 posts)2 days before my appt.i got a message from the place i was having it dont that they had NO anesthesiologists in my network even though the facility was. i had a choice.cancel or pay a couple thousand out of pocket. at least they told me in advance.
as far as im concerned if the facility is in network all docs at teh facility should be in network too.
AllyCat
(17,446 posts)Worst care ever from that lot. Found out later they were actually part of some other outfit.