Surprise Medical Bills And Balance Billing: ‘It’s A System Totally Rigged Against Patients’
Patients who do all the right things to go to an in-network hospital can still get stuck with thousands of dollars of surprise medical bills because the doctor treating them is out of network. The Houston Chronicle investigates why that is.
Houston Chronicle:
Feud Between Doctors, Insurance Companies Leave Texas Patients With Surprise Medical Bills
[Jason] Pettit, like so many others in this country, had tumbled unsuspecting into a multimillion-dollar business practice called balance billing. The murky system allows doctors outside a patient's coverage network to set higher rates and then shift any or all of the "balance" not paid by insurers onto patients to make up the difference. It happens most often in emergency care where vulnerable patients have no way of knowing in advance who will treat them. Often they find out too late that just because the hospital is in-network does not mean the doctor will be, too. (Deam, 11/17)
In other health industry news —
CT Mirror:
Anthem, Hartford HealthCare Agree On New, Retroactive Contract
Hartford HealthCare and Anthem Blue Cross and Blue Shield said early Saturday they had reached agreement on a new contract, ending a stalemate that had left Hartford HealthCare providers out of the Anthem insurance network since Oct. 1. The two sides said the agreement is retroactive so that all Anthem customers who received treatment from Hartford HealthCare providers will be covered at in-network rates as though there had been no disruption. (11/18)
Modern Healthcare:
Advisory Board Finalizes Deal With UnitedHealth's Optum
Shareholders and company executives finalized the Advisory Board Co.'s $2.58 billion deal with UnitedHealth Group and a private equity firm that will split the consulting group's healthcare business from its education arm, the companies announced Friday. UnitedHealth's Optum health-services segment will take over the Advisory Board's healthcare business for an estimated $1.3 billion, including its debt. The Advisory Board provides independent research, advisory services and data analytics for more than 4,400 healthcare organizations. (Kacik, 11/17)
Modern Healthcare:
EClinicalWorks Sued Over Patient Record Inaccuracies
EHR vendor eClinicalWorks is in legal trouble yet again, this time facing a putative class-action lawsuit that alleges that its software is flawed, creating inaccuracies in patient health data. The electronic health records vendor "has failed millions of patients by failing to maintain the integrity of patients' records" and has therefore breached its fiduciary duty, according to the complaint.In the suit, the relative of a deceased cancer patient alleges that eClinicalWorks misrepresented its capabilities to certifying organizations so it would be certified under the meaningful use program. (Arndt, 11/17)
California Healthline:
Health Giant Sutter Destroys Evidence In Crucial Antitrust Case Over High Prices
Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge. In a ruling this week, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.” (Terhune, 11/17)
