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As a physician who worked at @KFF during my residency, witnessed the start of @KHNews and value @philgalewitz's stellar reporting. This thread is an important commentary.
NOTE: surprise medical bill â your deductible.
The deductible is part of your insurance contract. https://twitter.com/ercoderguy/status/1265281508287434758
NOTE: surprise medical bill â your deductible.
The deductible is part of your insurance contract. https://twitter.com/ercoderguy/status/1265281508287434758
If paying your insurance company deductible is a surprise, you didn't read the BIG PRINT when selecting a plan.
That's one reason as an educator, I teach these simple insurance terms to docs/residents across the country.
This screen shot is from the patient's EOB.
That's one reason as an educator, I teach these simple insurance terms to docs/residents across the country.
This screen shot is from the patient's EOB.
Now COVID-19 complicates things because now patients (aka *consumers* if you are an insurance company) are supposed to be immune from paying anything**.
See reporting from @emmarieDC: https://khn.org/news/in-fine-print-hhs-appears-to-ban-all-surprise-billing-during-the-pandemic/
See reporting from @emmarieDC: https://khn.org/news/in-fine-print-hhs-appears-to-ban-all-surprise-billing-during-the-pandemic/
**anything â everything
The COVID balance billing ban, which I think is a reasonable measure to prevent profiteering during the pandemic, does NOT apply to normal contractual in-network amounts such as co-pays, co-insurance, and deductibles.
That's where this story focuses
The COVID balance billing ban, which I think is a reasonable measure to prevent profiteering during the pandemic, does NOT apply to normal contractual in-network amounts such as co-pays, co-insurance, and deductibles.
That's where this story focuses
But, by conflating the term surprise bill to describe BOTH:
(a) a balance bill by an out of network facility or physician
-and-
(b) an in-network contractual patient responsibility
@KHNews is doing a disservice to the debate.
(a) a balance bill by an out of network facility or physician
-and-
(b) an in-network contractual patient responsibility
@KHNews is doing a disservice to the debate.
Balance billing has the potential for serious manipulation by health care providers.
EMTALA has the potential for serious manipulation by insurance companies.
"Surprise Billing" policy proposals seek to remedy this in one of 3 ways.
EMTALA has the potential for serious manipulation by insurance companies.
"Surprise Billing" policy proposals seek to remedy this in one of 3 ways.
1) Benchmarking - lets either the gov't or insurance company determine the right "price"
2) Network matching - making sure docs that work inside hospitals all accept the same insurance plans
3) Arbitration - gets patients off the hook & lets insurance and docs fight it out
2) Network matching - making sure docs that work inside hospitals all accept the same insurance plans
3) Arbitration - gets patients off the hook & lets insurance and docs fight it out
ALL THREE SOLUTION GET PATIENTS OFF THE HOOK
I have my preference for which of these 3 solutions is best.
So do insurance companies.
And many, many, many constituencies have come out in favor or against one or more of these solutions to balance billing.
I have my preference for which of these 3 solutions is best.
So do insurance companies.
And many, many, many constituencies have come out in favor or against one or more of these solutions to balance billing.
But, so I don't wind up in arguments on the internet all day, I'll stop here at the treetops without getting into the weeds.
Just wanted to make sure journalists @KHNews & @NPR do a better job next time ensuring they don't confuse people by claiming deductibles are a surprise.
Just wanted to make sure journalists @KHNews & @NPR do a better job next time ensuring they don't confuse people by claiming deductibles are a surprise.
There is NO SURPRISE that insurance companies want to hoard your cash and avoid paying for *anything*
