Senators Unveil Legislation To Protect Patients Against Surprise Medical Bills

Yves here. This sort of basic protection against some of the worst medical billing abuses is long overdue, but still does not go far enough. Someone need to take language from securities laws and make medical bills and disclosures live up to that, particularly since patients are supposed to go shopping for treatment, yet can’t even get basic price information. Why not start by repurposing Rule 10b-5?

It shall be unlawful for any person….

(a) To employ any device, scheme, or artifice to defraud,

(b) To make any untrue statement of a material fact or to omit to state a material fact necessary in order to make the statements made, in the light of the circumstances under which they were made, not misleading, or

(c) To engage in any act, practice, or course of business which operates or would operate as a fraud or deceit upon any person, in connection with the purchase or sale of any security.

By Rachel Bluth, Peggy Girshman Fellow, who was previously the lead political correspondent for the Annapolis Bureau of Capital News Service, where she covered the Maryland General Assembly and Gov. Larry Hogan. She has also written for the Maryland Reporter and the Prince George’s Sentinel. Originally published at Kaiser Health News

With frustration growing among Americans who are being charged exorbitant prices for medical treatment, a bipartisan group of senators Tuesday unveiled a plan to protect patients from surprise bills and high charges from hospitals or doctors who are not in their insurance networks.

The draft legislation, which sponsors said is designed to prevent medical bankruptcies, targets three key consumer concerns:

  • Treatment for an emergency by a doctor who is not part of the patient’s insurance network at a hospital that is also outside that network. The patients would be required to pay out-of-pocket the amount required by their insurance plan. The hospital or doctor could not bill the patient for the remainder of the bill, a practice known as “balance billing.” The hospital and doctor could seek additional payments from the patient’s insurer under state regulations or through a formula established in the legislation.
  • Treatment by an out-of-network doctor or other provider at a hospital that is in the patient’s insurance network. Patients would pay only what is required by their plans. Again, the doctors could seek more payments from the plans based on formulas set up by state rules or through the federal formula.
  • Mandated notification to emergency patients, once they are stabilized, that they could run up excess charges if they are in an out-of-network hospital. The patients would be required to sign a statement acknowledging that they had been told their insurance might not cover their expenses, and they could seek treatment elsewhere.

    “Our proposal protects patients in those emergency situations where current law does not, so that they don’t receive a surprise bill that is basically uncapped by anything but a sense of shame,” Sen. Bill Cassidy (R-La.) said in his announcementabout the legislation.

    Kevin Lucia, a senior research professor at Georgetown University’s Center on Health Insurance Reforms who had not yet read the draft legislation, said the measure was aimed at a big problem.

    “Balance billing is ripe for a federal solution,” he said. States regulate only some health plans and that “leaves open a vast number of people that aren’t covered by those laws.”

    Federal law regulates health plans offered by many larger companies and unions that are “self-funded.” Sixty-one percent of privately insured employees get their insurance this way. Those plans pay claims out of their own funds, rather than buying an insurance policy. Federal law does not prohibit balance billing in these plans.

    Cassidy’s office said, however, that this legislation would plug that gap.

    In addition to Cassidy, the legislationis being offered by Sens. Michael Bennet (D-Colo.), Chuck Grassley (R-Iowa), Tom Carper (D-Del.), Todd Young (R-Ind.) and Claire McCaskill (D-Mo.).

    Cassidy’s announcement cited two recent articles from Kaiser Health News and NPR’s “Bill of the Month”series, including a $17,850 urine testand a $109,000 billafter a heart attack.

    In a statement to Kaiser Health News, Bennet said, “In Colorado, we hear from patients facing unexpected bills with astronomical costs even when they’ve received a service from an in-network provider. That’s why Senator Cassidy and I are leading a bipartisan group of senators to address this all-too-common byproduct of limited price transparency.”

    Emergency rooms and out-of-network hospitals aren’t the only sources of balance bills, Lucia said. He mentioned that both ground and air ambulances can leave patients responsible for surprisingly high costs as well.

    Lucia said he was encouraged that both Democrats and Republicans signed on to the draft legislation.

    “Any effort at the federal level is encouraging because this has been a challenging issue at the state level to make progress on,” Lucia said.

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  1. fresno dan

    I would suggest that doctors and hospitals, to be licensed, must accept medicare assignment rules.
    what is assignment?
    A doctor who accepts assignment has agreed to accept the Medicare-approved amount as full payment for any covered service provided to a Medicare patient. The doctor sends the whole bill to Medicare. Medicare pays the 80 percent of the cost that it has decided is appropriate for the service, and you are responsible for the remaining 20 percent.*
    A doctor who doesn’t accept assignment can charge up to 15 percent above the Medicare-approved amount for a service. You are responsible for the additional charge, on top of your regular 20 percent share of the cost. The doctor is supposed to submit your claim to Medicare, but you may have to pay the doctor at the time of service and then claim reimbursement from Medicare.

    There would have to be a couple of modifications – your insurance company would pay the percentage it would pay if you were in its network OR if you were in a fee for service plan. I even thing it would be OK for hospitals and doctors to be able to charge the 15% over assignment. But the important point is that it would not be ANY price a doctor or hospital could get away with.

    From the article:
    Our proposal protects patients in those emergency situations where current law does not, so that they don’t receive a surprise bill that is basically uncapped by anything but a sense of shame,” Sen. Bill Cassidy (R-La.) said in his announcement about the legislation.
    Cassidy’s announcement cited two recent articles from Kaiser Health News and NPR’s “Bill of the Month”series, including a $17,850 urine test and a $109,000 bill after a heart attack.

    The thing that can never be said about assignment is the simple but NECESSARY aspect of it – it controls prices and NOT WHAT THE MARKET will bear OR price restraint by a sense of shame. I think the evidence is overwhelming that a sense of shame doesn’t restrain sh*t.
    Emergency medical care is not amenable to “free market” shopping. Medical care is licensed and insurance companies are regulated because a totally free market would be a disaster.

    *medicare patients who are on “original” medicare, i.e., fee for service, typically deal with this 20% by buying extra insurance, i.e., “medi-gap”

  2. french75

    As a young person, I have to ask: what was healthcare like in the 1980s? Were US hospitals just gussied-up mortuaries? If healthcare is so much more expensive, has it gotten significantly better? Or would it be a good deal all-round to return to 1980s healthcare with 1980s prices?

    1. Isotope_C14

      I don’t know what the 5-star hotel of Northwestern University Hospital looked like in the 80’s, but I suspect it certainly wouldn’t have had a 5-star hotel rating, and 9 nurses per patient. I was visiting a friend there some years back, and it was obscene.

      Just like every other industry across the US, the coddling of the 0.1% to the 10% has essentially drained any service from the “poors”.

      I was a kid in the 80’s and everything was covered by my Dad’s work insurance, aside from the co-pay. Orthodontic work was not covered, but basic dentistry was, with a small co-pay.

      I’m now forced to work in Germany in science, because the US has no interest in having R&D that isn’t about making new drugs, and I’m “too old” and “they would have to pay me more”, and they profit off of global basic science instead.

      German medical care: Had a pneumonia this summer, coughed and cracked a rib (from an ancient injury). Total cost – 0. Full refund on all the medications. Saw a dermatologist last year, total cost – 0, medications – 0.

      Perfectly clean hospital, friendly, excellent multi-lingual staff, even the receptionist was fully fluent in English.

      At the pharmacy, they said the doctor didn’t give me enough painkillers, and increased the amount. I’ll take German healthcare over the US any day.

      Sure they take some out of your taxes for it, but with the cost of everything here, you can actually save cash, and you certainly don’t need to help be a planet-killing driver here with the great trains.

      I know the “medicare will never-ever come to pass” lobby thinks you can’t get rid of all those jobs robbing the poors, but you sure could accept more people into medical school and drastically increase the number of doctors.

      To be perfectly honest, the doctors are over-schooled in textbooks and under-schooled in practical application, and experiential diagnosis. I knew some old-time doctors in the early 90’s and they were vastly superior to the younger kids with more schooling.

      1. random

        Agree. One of the most idiotic trends in medical education over the last 30-40 years has been the rise of the “General Practice” or “Family Medicine” specialty. Doesn’t that sound like an oxymoron to you?

        It used to be that you could go to medical school, get an MD, drop by the state licence office, and hang out your shingle. Something like half of the doctors decided that they wanted to practice now, and not spend another 3-6 years becoming a specialist. Today, there is no choice. To be a plain old doctor, you still need another 3 years of training.

        I know a few doctors socially. Half of them think that there was no point in getting a specialty. In fact, half of them never used their specialty at all. (e.g. A guy who became an Ophthalmologist and then ended up doing general practice/running a tiny hospital in rural Florida. Never did a single RK, as far as I can tell.)

        The practice of requiring people to take a specialty is just credential inflation.

        1. Anon

          MD’s are not required to develop a specialty. General Practice and family physicians are in short supply (they are the lowest remunerated class of physicians). They do more real work (see more patients) than specialists (Cardiology, Surgery, Oncology) and are the most important part of the healthcare system. (Seeing and identifying health problems early saves the system money.)

          1. Jen

            But the specialists are the ones who perform procedures, with the associated complex diagnostic tests, and administer expensive drugs, hence: profit! Which is why they command much higher salaries than general practitioners. A friend of mine used to be the section chief of the General Internal Medicine service at the major health care center in our area. The health care center experimented with an incentive pay program for a while during his tenure. None of the GIM physicians were eligible because even thought they met all of their “metrics” for productivity and care standards, they weren’t generating a profit. My friend was able to persuade the c suite that giving his physicians incentive pay anyway would be vastly preferable to losing a lot of general practitioners over a scheme that unfairly penalized them while rewarding all of the specialists to whom they referred their patients. The HCC eventually abandoned the incentive plan.

      2. JerryDenim

        Thank you for your account. I have lots of European friends, and no matter how many positive second-hand anecdotes I recount, most Americans that I interact with think single-payer or “socialized” medicine is some horrible failed Stalinist experiment with ‘death panels’, rationing, very long waits, and antiquated practices. Most of the rest, the ones who concede that it works well in Europe or elsewhere, will almost always argue; “But, it will never work here, we’re too different…”

        Americans need to be bludgeoned with positive stories of single payer until they relent. Our system is truly horrible. It only works for the healthy or the lucky few. I believe the cost of it combined with the employer-linked coverage model is a big driver of why Americans are so overworked compared to their peers. US business has to squeeze the absolute most out of every worker since each employee represents a significant additional cost.

    2. rd

      The technology and drugs were not as advanced or available. There were fewer specialists and they weren’t paid as well as now. GPs could actually make a living.

      Other countries have kept costs closer to the 1980s levels using better cost control and far less administrative costs. Their society wide outcomes are generally as good or better than the US but at half the cost.

      Everybody in the US is focused on “how to pay for it” but the real problem is “why does it cost so much?”. Other countries are providing universal or near-universal healthcare at a fraction of the per capita cost of the US. The US actually spends more money per capita of PUBLIC healthcare spending than all but 2 other countries, so it is not lack of money that is the problem.

    3. Louisa

      I had a C-section back in the 80’s. Hospital stay was 5 days. Total cost to me (insurance through my employer) was $50 because I opted for a private room at an increased cost of $10/day. Everything else was covered.

    4. NotTimothyGeithner

      I’m not that old to really remember.

      The U.S. is quite large (Are you French? I’ve found Europeans often don’t grasp the size of the U.S. on an emotional level and skews their perception) and by the 1980’s was on a practical level in the process of a 370 year expansion. After the American Revolution in charge were the people who had been in charge. Its important to recognize this. World War II wasn’t that big of a deal.

      The states wielded a fair amount of power over healthcare policy and implementation of government programs especially when the state was weaker. U.S. policy tended to have an outlet in Western expansion which kept labor costs relatively high, its why the South needed slaves (without AC, August in Virginia can be miserable).

      One important item is the HMO Act of 1973. It was basically illegal for for-profit medicine to work, hence why the hospitals had name like St X, First Presbyterian, City General, and so forth. The Doctors worked as private contractors. They could command high salaries. After this bipartisan bill, championed by Ted Kennedy and Dick Nixon (so you know its good), the entry requirements for for-profit hospitals dropped and amazingly enough prices rose while results declined.

      The insurance situation is tricky. The insurers grew when there was non-profit hospitals and better employee funded healthcare, so I don’t think they ever developed the structures to go back and investigate hospital pricing and contesting charges and simply paid the claims, necessitating a rise in premiums. They are greedy too, but they should face more competition than a hospital. When you are sick, you don’t shop around on Kayak unlike the Obama White House suggestion. At the same time, employee benefits were often better, so legal departments of corporations might get involved. Having an employee morale problem when its harder to replace workers is problematic. Short term quarterly results are a huge problem because even the insurer isn’t thinking long term which they need to do and look for ways to avoid paying the bills instead of asking what those bills are and whether they make sense. Hospital CEOs don’t make fortunes healing people.

      On one side, poorer communities would have a harder time attracting doctors and building hospitals. If you haven’t Doc Hollywood is probably a good example of that. There would be a natural place for many communities to embrace for-profit medicine because they couldn’t do it on their own because they simply can’t get a doctor to stay. The old system wasn’t working in the hither-lands either. The Howard Dean reforms made when he was governor of Vermont mirrored the programs that were in place when my mom was a kid, but they had been disband for 40 years in between, long before the HMO Act of 1973. There were problems, and those problems were magnified in the South, Appalachia, and throughout much the West where communities were more rural.

      When I was on the public option sham band wagon, the selling point was the private sector can’t beat any kind of government insurance. Inevitably, the private sector would lose which would provide a transitional period. Lambert will dismiss that idea as pie in the sky reasoning, and he’s right. When you look at the system and how healthcare is delivered, only Medicare for All works. Given the economic situation among young people, 5 year phase increments won’t work anymore. It will be just a repeat of the two wage union problem while we have a crisis.

      Yes, healthcare was better in the 1980’s, but its not a simple thing to just go back. There were problematic areas. The economy is different. The delivery systems are different. Smoking is going to skew results. People who might have been done in by smoking at 65 are now using the healthcare system because they didn’t smoke. Its important to recognize this is a long term decline. It didn’t suddenly happen, and most people don’t notice it because we don’t get sick everyday. We usually complain about insurance companies because we pay the premiums on a scheduled basis, but the U.S. is a very sick place. Much of my original disdain for Obama (I always thought he was shallow) extends from the power and opportunity he had to take steps to change the system in positive ways with a commanding election and the ability to squeeze the usual suspects within the Democratic Party (if not for this Blue Dogs!), but it was quickly apparent that he had no interest in disruption as much as preserving a sick system by basically redirecting treasury dollars to insurance companies so they could pay the increasing costs levied by the HMOs with no kinds of cost control involved.

      The only way out of Wonderland is through.

      1. Lambert Strether

        > Given the economic situation among young people, 5 year phase increments won’t work anymore. It will be just a repeat of the two wage union problem while we have a crisis.

        Two-tier must be assaulted where found.

    5. NotTimothyGeithner

      Also, all hospitals are gussied-up mortuaries. You come out with a baby or you leave in a hearse. Avoid a hospital.

      1. d

        My real aversion to hospitals isnt these, its that you will be bankrupt. and after the little exposure to it we have had to it, its just no longer worth it

    6. Chris

      If I had today’s money and 1980’s or even 90’s prices, that might be OK.

      Healthcare and access to healthcare has become significantly worse for me since I started having my only policy and paying my own bills in 2000. The change in costs for having a child, let alone child expenses, ballooned with each one until when our 3rd was born, there was no way we could have afforded to have her without the fantastic insurance my wife had through her employer. My first child, born in 2004, “cost” $600 in total fees after insurance had paid for things. My third child, born in 2010, cost $4500 in total fees we paid, and we stayed in the hospital for less time and had less help from the doctors. We also had to pay for midwives and a doula. Those were on top of the $4500. The actual cost that our insurance was charged for kid #1, before negotiations, was around 8k$. The real bill for the third child was around $30000.

      These days, I can’t find a GP accepting new patients. The bills are all large. I never know what I’ll be charged. But, a silver lining is that I can’t be disqualified from insurance by a pre-existing condition. I can however, be denied care because no doctor will take me as a patient and I can’t afford the co-pays.

      Bottom line – medical insurance and costs have been awful my entire life, they’re worse now, and I have no reason to believe they were any better years ago.

      1. d

        Well having lived and worked in the 80s, can say it did seem to work better, but that was more because medical costs hadnt ballooned since then. that forces insurance companies to do all sorts of schemes to cut their costs. now are they just reacting to that, nah. they could have pushed harder on costs in any way they could. same for our government. they just ignored it. and employers did the same until it got out of control. course us ‘consumers’ didnt help it much (mostly for what we did and ate. some of that might be because of what we could afford to eat) . long story short we can see who did part of it in a mirror. but not a large part

    7. ArcadiaMommy

      According to my parents (I was little in the 80s): the hospitals in the 80s didn’t have luxuries like valet parking, Starbucks or other boutique coffee shops, they did not have art exhibits or sculpture gardens. The gift shop did not sell clothing and expensive knickknacks. Floors were linoleum, not travertine. There was no special room service menu.

      Now you have all these things in certain hospitals, including spa treatments. Why you would get a manicure or a pedicure in a place that is so germ-ridden that you are given nail files to trim your newborn baby’s nails because clipping them is an infection risk is something I can’t figure out.

      The average US citizen seems less healthy so I can’t imagine that care is better.

      1. Mel

        Yeah. Well, my take — and you know it already — is that you can bill cost-plus for mani/pedicure, and it keeps other hospitals from luring away the really valuable patients.
        Paying somebody to mop around the baseboards with bleach is just an expense, and icky also, and depresses the customers when they see it.

    8. Katniss Everdeen

      Just my personal recollections:

      Orange juice, hot tea with lemon, chicken soup and aspirin were the drugs of choice during “cold and flu season.” We covered our mouths when we coughed or sneezed and washed our hands with plenty of soap after, and stayed home in bed until we were better. Vicks Vap-O-Rub was a miracle drug.

      “Nausea” was called upset stomach and was treated with room temperature 7-Up or ginger ale (not diet) and soda crackers.

      People understood what the word “emergency” meant.

      Doctors looked directly at you when you told them what was “wrong,” and seemed to actually be thinking about what you were telling them.

      Most people only knew what hospitals looked like on the inside because they visited their Grandpa there when he was “sick,” or their Mom when their baby brother was born.

      Hospitals were few enough and far enough between that you could use them as landmarks when giving directions i.e. “Turn left when you get to St. James.”

      Not one of my friends ever lost their house because one of their kids broke their arm.

      Hypochondriacs were made fun of.

      1. Isotope_C14

        Hypochondria is most likely a condition due to not enough parental physical contact with children, as hugs, nothing creepy. Many people I know who were raised with deeply Christian/Conservative values end up having these sorts of problems. Not enough physical contact does long term damage whwn you are young. As adults they tend to a predisposition to acceptance of woo-woo Chinese medicine baloney.

        See, paying cash for something that does nothing makes it a service and not a sin.

        I can’t drink 7-up without thinking of throwing up. Thanks for that memory, hahaha.

        1. Yves Smith Post author

          I come from a family with very WASP habits and none of the kids became hypochondriacs. And the one hypochondriac I know personally was not that way until she had a bad reaction to some meds as an adult and became exceedingly allergic. She can eat pretty much only white potatoes and chicken. And I’ve seen her rapidly turn green when exposed to something that bothered her. So she’s wound up hospitalized for real reasons so often that her life has come to revolve around trying to avoid that, which results in obsessiveness about any little health anomaly.

          Shorter: I’d be careful about sweeping generalizations, particularly since you haven’t cited any research to support your opinion.

          1. markodochartaigh

            Another thing that always annoys me is when people say “you shouldn’t go to the emergency room unless it’s an emergency”. I worked in Parkland in Dallas for 29 years, about 3 years doing triage in the ER. Even in a system where an experienced RN can have a doctor instantly at hand mistakes are made. Thankfully no one died because of a mistake I made, but I know of deaths that occurred where I probably would have made the same call. To expect a patient with no medical training to know what is truly an emergency and to be able to apply that knowledge to their own symptoms in one of the most stressful periods in their life is an absurd expectation.

      2. rd

        Here is an interesting study of how much life could be extended from birth if specific diseases and causes of death were eliminated.

        The biggies are cardio-vascular and cancer. So it is likely that if people exercised, treated diabetes (probably a major factor in the cardio-vascular), took their generic high blood pressure and cholesterol medicine if those symptoms showed up, didn’t smoke, and avoid major environmental toxins (workplace air, urban air pollution, etc.) , then much of other aspects of modern medicine would be important for early onset individuals but most people would likely get into old age in fairly decent shape without much interaction with the medical system.

        One of the reasons that the “socialist” systems in other countries are doing fairly well is that they have figured this out and are focused on keeping people out of hospitals by dealing with chronic problems before they become acute. The single payer insurance and doctors appear to be focused on this goal based on personal experience with elderly parents in a Canadian province. They are using big data to figure out what issues cost lots of money and getting out in front of those (diabetes is a big one as it is a precursor for other problems).

        Unfortunately, it appears as if most current official US policy appears to be heading in the opposite direction.

      3. Lambert Strether

        > Doctors looked directly at you when you told them what was “wrong,” and seemed to actually be thinking about what you were telling them.

        As opposed to filling out electronic forms* on their tablets.

        * Horridly designed, broken

      4. ChiGal in Carolina

        Yup. But probably the population was healthier then. And as others have noted, many fancy procedures and meds had yet to be developed.

  3. tegnost

    …getting in front of a riot and calling it a parade. I expect more superficial “fixes” as the population further chafes at the grift that is health maintenance in america. We’re maintaining a bloated administration of disbursments to protected industries, all the while it’s main beneficiaries, wall st., chatter about the “free” market. As with the CalPERS, it’s all managing the grift and paying off your buddies while being unconcerned about the people who make up the true constituency, in this case people with health problems, in CalPERS case the beneficiaries. Thanks for covering these glaringly obvious scams, too busy lately to get into the comments, unfortunately, but plenty to think about at work from the posts, and thanks to all the commenters and link searchers as well…won’t make a list, it would be too long and inevitably leave someone out…oh and since I’m here now, that 40% default rate on student loans which turn out to be basically high value treasuries for people who’s kids will never be saddled with a student loan, how much longer can this all go on?

      1. polecat

        If you’re a stiff member of that bicameral ‘2-chambered blackhearted organ’ then it’s $all$good$ !! They don’t have to know what the costs incurred are, as their congressional T-cells are immune to whatever actuarial viral particles are that spread and infect the lumpin lowers ..
        The above .. uh .. ‘legislation’ .. appears to me as pre-election theatre, to be slow-walked into oblivion, trying to do its job of hoodwinking the desperate .. nothing more !
        The good senator, and his golden-cloaked ilk might want to watch out, as the white-walkers have started breaching the Wall, and are heading their way come November ..

    1. Jim

      We don’t need new legislation to “protect “ people from surprise bills, we’ve already got Sherma/Clayton etc, known as 15 USC 1 and we’ve had it for 100 years. Now if we could just find someone to wield it… Jeff Sessions? Eric Holder? Etc etc etc? California has it’s own version, so where was Jerry Brown when he was AG?

  4. Synoia

    The Kaiser copay was $1.00

    My infant son was in hospital for 4 days. The treatment was covered by IBM’S employee medical plan. I do not remember any copay.

  5. sajsan

    These are all stop gap measures introduced by the paid medical industry proxies in the Senate and Congress. These are just delaying tactics and measures to show that legislators understand the pain the citizenry is facing and are empathetic. These legislators do not have the inclination, interest and dedication to introduce and implement policies which benefit the country and its citizens like Single payer and M4All.

    1. DHG

      Eviscerating the for profit health insurers and an employers ability to dictate what insurance benes people will get empties their re-election coffers

  6. Bobby Gladd

    I’m recovering from open heart aortic valve replacement surgery 4 weeks ago. Can’t wait to see the avalanche of bills from every conceivable “independent contractor” source. Even prior to my heart px, my BS year-to-date EOB “chargemaster” list price aggregate was about $120k.

    I’m now Medicare A and B, with a Part F high-deduct Medigap supp, so, my exposure should be fairly limited. We’ll see.

    I cover the health tech space. There’s been a LOT of VC chatter of late about getting into the “financing” arena. Bears watching. I also used to be a subprime credit risk analyst. Lots of room for mischief upcoming. Were I thinking of doing a “startup,” med finance would probably be easy money.

    1. Tom Stone

      Remember you can negotiate those bills down quite a bit, as much as 60% if you are good.
      Just don’t have a heart attack when you first open the envelope…
      I spent a week in a cardiac ward earlier this year…luckily I had a nice escrow close shortly afterward and I am a good negotiator.

  7. MaxFinger

    Do you trust any of these people to sponsor any bill that is not in the pocket of BIG corporate BS?
    Single payer would eliminate all this….but NO! Blue Dogs Unite /sarc

    Dr./Sen. Cassidy (R-LA) Sens. Michael Bennet (D-Colo.), Chuck Grassley (R-Iowa), Tom Carper (D-Del.), Todd Young (R-Ind.) and Claire McCaskill (D-Mo.)

    1. Jonathan Holland Becnel

      As a LA resident, Cassidy is fn nuts. Most people think Kennedys nuts too but hes more Trumpian. Cassidy would of course be Pence.

      Ugh cant wait for some actual populists to run. We are gonna be seaux socialist its not even funny!

      Tic Toc, capitalists.

    2. Big River Bandido

      While there’s merit in the substance of attacking “balance billing”:

      1) Balance billing is a feature of the for-profit model, not a bug.
      2) The proposal is a stop-gap, not a fix.
      3) Stop-gap measures usually fail, unless their purpose is merely to delay or stop real reform.
      4) The bill’s sponsors helped cause these problems and still cannot even diagnose them; they certainly won’t be able to solve them. )
      5) Not one of those Senators has any credibility on healthcare. Or anything else, for that matter.
      6) The chances of the bill becoming law are zero.
      7) After the election they’ll drop the idea completely (it having served all its value).

      The worse this nation’s crisis gets, the better our chances of tossing out the people (and corporations) running it into the ground. There’s no hope of serious change in Congress this fall, but at least at the state level we can make inroads for the future.

      1. Lambert Strether

        > Balance billing is a feature of the for-profit model, not a bug.

        The profit motive is like a balloon; squeeze it one place, it bulges out another. So we made it easier for people with pre-existing conditions to get insurance, which squeezes the balloon. And the balloon bulges out with all this balance billing fraud, along with price increases elsewhere.

        So this bill will squeeze the balloon in a new place…

  8. zagonostra

    The Medical Insurance “system” in the U.S. is an abomination. Everyone has heard that Starbucks spends more healthcare for it’s employees than it does on purchasing coffee, and GM…you know the rest.

    So why are businesses not lining up to get this monkey off there back? Why isn’t Bezo pushing his WaPo to editorialize on M4All?

    Then there is the moral component, which puts the U.S. system in the same league as Beelzebub

    1. d

      Possibly they think they can do it better (so far thats been a complete failure) not that that will make them change. plus they have bought into only the private sector can manage this. even the same that drives them ,drives the health industry.

  9. Paul P

    NYS has had a surprise billing and emergency services law since March 31, 2015. I found out about it when confronted with an Advanced Beneficiary Notice on an ipad at NYU Langone. The ABN says that the patient is responsible for the bill, were insurance not to pay. Previously, I had been writing on the written ABNs that the provider would only have recourse for payment from my insurance and not from me. The ipad had a restricted answer of yes or no. So, I refused to sign the ABN. I had conversations in someone’s office who told me about the NYS surprise billing law.

    I have since doubled up by emailing the business department that I would only be responsible for what my insurance paid and not be personally responsible for any bills.

    Billing and services has been going smoothly, so I may be dead before my ABN revolt gets litigated.

    1. a different chris

      > I would only be responsible for what my insurance paid and not be personally responsible for any bills.

      Are you a “gentleman”… that is, one of the elite that decides himself what debts he wishes to pay? If not, good luck.

      1. Paul P

        The doctor and hospital ask for your insurance and for your signature that you agree to be responsible for the bill were the
        insurance company not cover the bill.

        Without the signature or notice of your personal responsibility for
        the bill, there is no contract and the provider is stuck with what the insurance pays.

        The ABN is important for Medicare patients like myself. The provider is not supposed to ask a Medicare patient to sign an ABN, unless the provider has reason to believe Medicare will not pay for the service. Sign the ABN and you’re on the hook for the bill

        These rules saved me $5,738.15 for a pet scan.

  10. Susan the other

    Re Securities Law 10-b-5. That is a gem. I do believe it could solve all problems everywhere. It must have been construed without any real teeth. Like the intention to commit fraud is almost impossible to prove. So the crux of stopping all these loopholes wherever they are should be a more definitive set of criteria, obvious misdeeds, leading to fraud – whether achieved or not. And to that end yesterday’s piece on central banks and their obsession with inflation instead of guiding the economy responsibly might be informed. We allow way too much stuff to slip under the radar or slither through it with double talk. But if we took a systemic view of the situation the solutions would appear. Bill Black might approve.

    1. Yves Smith Post author

      SEC mandated disclosures for registered securities are extensive and have to be written in layperson English per SEC regulations under rule 10b-5. A 10b-5 standard would make it impossible for hospitals to issue incomprehensible bills or engage in trick like putting an out of network MD in the operating room, particularly when the patient made efforts for that not to happen.

      1. Anon

        That’s exactly what transpired with my hospital stay in 2009. Made explicit instructions, in writing, to hospital staff and surgeon that ALL doctors in the operating room must be In-Network physicians (insurance requirement). Weeks later I get bills from two out-of-network thoracic physicians who said they were in the OR, but not known to me. I told them to send the billing to my insurance provider. The doctors refused the insurance payment amount and sent their bill to collection. They ended up with nothing.

        1. Yves Smith Post author

          I am sorry you had to go through this, but good for you for staring them down. Many people can’t afford to due to credit ratings concerns (not just for possible future borrowing but if they think they’ll be in the job market). That’s a big reason this crap continues.

          So another nice legal change that will never happen is that disputed medical debts should be removed from credit reports.

          1. Anon

            Yes, I knew I wasn’t in the “many people” category. It was a matter of principle. One bad turn of Trust deserves another.

            I can say that my experience with hospitals and insurers has made me a Universal Healthcare acolyte.

  11. Knot Galt

    10 years ago I underwent treatment for Non-Hodgkins Lymphoma and my wife’s insurance plan covered over 99% of my payments. The total bill, as I recall, was in the neighborhood of $ 130,000 and my out of pocket over a 8 month period was just below $2,600. I had lucked into the best lymphoma oncologist in the country and had to fight the insurance company tooth and nail to get the coverage to see him. Luckily for me, the insurance provider relented probably because I had the State public school plan behind us. ( I believe it was because of my wife’s coverage which was provided to her as a teachers benefit.) I recieved excellent care throughout and I am alive today because of it.

    Last year, I was sent into a hospital because the Urgent Care facility my doctor sent me to did not have the necessary tools or doctors to diagnose my condition. My first visit to the hospital charged me $2,400 and sent me home with a compression bandage and advice to stay off my feet for 3 to 5 days. Within two weeks the end result was I picked up a staph infection, I assume at the hospital, and swelling in my knee cap. Again, Urgent Care facilities did not have the proper tools and I was sent to the hospital again where I was diagnosed after spending two days in the critical care unit. The specialist to do the work could only come in on a Sunday and I had no choice or offers to do anything else but. In the meantime, I had all sorts of contractors come hawking their wares and services and essentially telling me I had to use their services. Afterwards, my insurance agency claimed I did not make my monthly payment in time. (Which was true; I was doing month to month & I missed the payment while I was in the hospital.) A bill collector came after me 61 days after I left the hospital with a bill for just over 14K. I filed Chapter 13 two months later after that.

  12. Amfortas the Hippie

    Aye.not even a freaking bandaid. Mere theater for run up to November.
    Wife’s been in hospital for a week(info gathering phase of being diagnosed w stage 4 colon cancer), and I have yet to see a price tag on anything…and when I ask, it’s apparently some kind of faux pas…”we,re not worried about that right now”.
    Nurses doctors broomhandlers…even the money lady…have been super nice…great, in fact…but without price discovery, it ain’t a “market”.
    I can’t freaking wait to start getting the bills.

    It’s texas…so Medicaid is nonexistent, but the hospital has an office dedicated to charity moneygathering(!!)…and our little town has sprung into action with bake sales, a time bank at the isd where she works, and numerous go fund me type things.
    I sit outside the place with coffee in the rain and think,” this doesn’t really look like the third world…”

    1. Anon

      Get ready for a shock AtH. Oncology treatment is more than expensive. Totally prohibitive without excellent medical insurance

      1. Amfortas the Hippie

        I’m beyond shock when intersecting with the fire economy.
        It’s of little comfort, but I know we’re not alone…it’s of note, I think, that the social worker seems always on the verge of tears.
        Sisyphus rides upon her shoulder.

      2. hoonose

        And this is one of the reasons HC premiums are so high. As compared to the 1980’s much more high tech medicine is done. Many more lethal conditions like cancer can now be treated. And most of that is extremely complex and expensive. Premiums are up because we all share that risk.

        My wife is now day #41 post-stem cell transplant. Haven’t seen any bills yet. But they are bound to add up to $M easy. Thank you all that are in my wife’s BXBS Obamacare plan.

  13. Duck1

    Things I saw working in a relatively small (50 people) but quite profitable mfg. business since the eighties.
    1. Monthly expense for employee went from low hundred $ for family coverage to well over thousand $ per month.
    2. Family coverage was eventually dropped, requiring employee covering cost.
    3. Increasing health cost was given as a reason for no raises in cash compensation.
    4. Co-pays for services increased dramatically, and coverage dropped for certain services.
    5. About a quarter of the line production staff were sourced from temp agencies, hence no benefit cost.
    Neo-liberalism in action, I guess.

    1. Dianne Shatin

      Reason for unaffordable health insurance:

      1. MBA’s not physicians run all aspects of heathcare..
      2. Healthcare in America is hideously inflated;
      3. MBAs borrow huge sums to build or add on to hospitals, for instance. Interest due paid for by inflating medical related costs..the physicians see little pay increase;
      As medical costs inflate, medical equipment and other hospital procurement is outsourced
      to the lowest cost globally, while inventory is kept “just in time inventory” thus causing unacceptable shortages of all kinds. Again courtesy of Harvard MBAs.

  14. Lambert Strether

    The entire health care system seems like a smash-and-grab operation except on a time-scale of years, not seconds.

    For example, we get the travertine floors and massage (rich patients) but also infections (cleaning is a cost).

  15. Jen

    “Mandated notification to emergency patients, once they are stabilized, that they could run up excess charges if they are in an out-of-network hospital. The patients would be required to sign a statement acknowledging that they had been told their insurance might not cover their expenses, and they could seek treatment elsewhere. ”

    So what’s the definition of “stabilized?” If it doesn’t mean that you are physically and mentally capable of a) understanding the document you’re being asked to sign, and b)leaving the out of network hospital to commence shopping for the services of an in network provider, without requiring immediate follow up care to remain stabilized, this seems like a rather large loop-hole, does it not?

    1. hoonose

      The stability of the patient is determined by the doc(s). It is a medical judgement. When stable if out of network a transfer can be made if you are stable enough for the transfer, and there is an accepting and appropriate doc(s) and facility.

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