Why Americans Are Drowning in Medical Debt

[cynzke]

70. NO, Not a lie.

And this is not new. It happened prior to the passage of ACA and will continue because ACA regulates insurance NOT hospitals/health care. The hospital/surgeon makes decisions on who will perform procedures. The insurance companies set up their networks of health care providers, but neither the insurance companies nor ACA have control over the hospital. If a doctor or surgeon is called in for a consultation or procedure, the insurance company can deny covering the fee if that doctor is not in their network. The bill goes directly to the patient to pay. So, there is a gap between the ACA law and laws that regulate hospitals. Should ACA be amended requiring insurance companies to cover ALL fees including those from outside their networks if medically necessary or should (state) laws that regulate hospitals require them to co-ordinate their procedures with the patient's insurance plan and use only doctors, surgeons, etc. in the insurance company approved networks? It is a gap that existed before ACA and still does, despite ACA. But consider this practice by the doctor calling in a colleague to help perform surgery. Is it really required or are they just helping boost each others income? You scratch my back and I'll scratch yours, wink, wink! Seems to me this is ripe for abuse.