Etiology of surprise bills explained (a thread)

Surprise billing” is a total misnomer created by profit hungry insurers that points finger at physicans

It is more accurate to call them “unpaid insurer bills”

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The ACA allowed insurers to insert clauses into plans that limit their responsibility for emergency charges.

Insurers then started tricking and pressuring patients into buying out of network benefits tied to Medicare or with no out of network benefits

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These plans were not only inadequate for elective services, but people didn’t realize - and insurers didn’t tell them—
that purchasing these plans with poor or no out of network benefits meant insurers didn’t have to pay their emergency out of network bill

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Insurers were in the meantime making networks much “skinnier” by dropping physicians out of their plans making it much more likely to see an out of network doctor for emergency or unscheduled services.

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Doctors don’t plan to submit “surprise bills.” We just provide services and submit bills. If the insurer pays, it’s just a bill. If they don’t, it’s a “surprise bill.”

It’s entirely up to insurers not us whether this happens.

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Remember in some states, insurers lobbied to require OON physicians to balance bill

Greedy insurers just routinely deny lots of completely justified medical bills, particularly from physicians, who they find easiest to push around.

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If Congress wants to be fair and seek the truth, they should insist on a thorough investigation into the insurer’s role in these unpaid “surprise” medical bills.

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