<p>I am very confident about BS… Anthem, I am hopeful. :)</p>
<p>I got a letter from BCBS asking my wife to sign to request them to cover some kind of breast cancer. Currently this type of cancer is not covered. I am not sure why we need to request them.</p>
<p>I would question the truth of that letter. </p>
<p>I just reread the letter. It’s from my employer. My employer plan with BCBS has coverage for that cancer diagnosis, but not all BCBS plans have that kind of detection coverage. It’s called 3D breast tomosynthesis.</p>
<p>Still. Under the new law, I’m not sure insurance companies can exclude specific illnesses. Otherwise they’d all exclude expensive diagnoses.</p>
<p>Calmom? </p>
<p>3B breast tomosynthesis is a new, expensive kind of mammography. I’m deeply skeptical that it is better than the old kind of mammography. I wouldn’t pay a nickel extra to get it.</p>
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<p>This is a scam that is perpetrated by doctors and allowed by hospitals. There was an article in the NY Times about emergency room doctors in hospitals in Texas, many of whom also accept NO insurance.</p>
<p><a href=“http://www.nytimes.com/2014/09/29/us/costs-can-go-up-fast-when-er-is-in-network-but-the-doctors-are-not.html”>http://www.nytimes.com/2014/09/29/us/costs-can-go-up-fast-when-er-is-in-network-but-the-doctors-are-not.html</a></p>
<p>So you go to your in-network hospital for your surgery, and you have your in-network surgeon do the job. And then SURPRISE! You get a huge bill from your anesthesiologist.</p>
<p>Or, you go to your in-network emergency room for your heart attack. Luckily you recover. Then you get another heart attack when you see the huge bill that the emergency room doc sent you.</p>
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<p>See? The emergency room doctors have figured out how to scam you. This should be against the law. We should enact Fang’s Law, which I’ve mentioned several times here over the months.</p>
<p>Fang’s Law: If a patient goes to an in-network facility, they are not liable for any out-of-network charges. Their insurance company is also not liable for any out-of-network charges. Any such charges must be absorbed by the facility.</p>
<p>If a hospital knew that it was responsible for all those outrageous emergency room doctor and anesthesiologist bills, it would make sure there weren’t any.</p>
<p>I was just reading a university student’s health insurance policy exclusions. Care needed due to commission of a felony is excluded, so is care needed due to participation in a riot. </p>
<p>I thought it was interesting. </p>
<p>No crime or rioting kids, lol.</p>
<p>Fang, the ER doctors can accept or not accept insurance. I do agree that there should be information provided to patients that insurance will not be accepted by the ER doctors. The insurance companies like this system. They can say a hospital is in their network, but they don’t have to pay for a large chunk of ER services, namely the doctor’s fees. </p>
<p>I’ve never been offered a choice of doctor when I’ve gone to the ER.</p>
<p>Anyway, I’m lying on the exam table having a heart attack, and I’m supposed to go doctor shopping? And in the Texas hospitals mentioned in the article, 2/3s of the ER doctors accepted no insurance. So there’s a good chance that as I’m lying there having a heart attack, not one ER doctor takes my insurance. This billing scheme is a scam, and it needs to stop. </p>
<p>Hear hear, Fang! </p>
<p>Tatin, re your suggestion that ERs inform patients about which doctors will accept which insurance: </p>
<p>Let’s say Fang is lying there in ER having her heart attack, and the hospital does exactly as you suggest – they inform her that the ER doctors treating her do not accept her insurance. What exactly should Fang do with that information at that point? Get on the phone and start calling around to the Billing Department of other nearby ERs (if she’s fortunate enough to have her heart attack during business hours)? Leave the ER and start driving around town? Tell them to keep their treatments to an absolute minimum? Ask for instructions on home-care for a heart attack? I’m just confused as to why you think this policy would help anything.</p>
<p>Everyone is operating under the rules they were given. The problem is no-one cared what the rules were. They just wanted to make rules immediately. There were people saying, “Uhm, these rules stink,” a long time ago.</p>
<p>Because Fang’s Razor is not in place, patients are screwed. We are trying to avoid getting screwed. </p>
<p>The misinformation or lack of information makes it hard to make rational economic decisions. </p>
<p>The insurance companies need to increase the ER docs reimbursements, then they’d accept insurance. If the ER docs are making better paychecks taking no insurance, then guess what? </p>
<p>So how do I make that happen at my local hospital, in case I have a heart attack next week?</p>
<p>The letter to the editor in the NY Times from the president of the College of Emergency Room Physicians says that insurance companies present the ER docs with a very low ‘take it or leave it’ reimbursement, and refuse to pay their usual rates. Meanwhile the ER docs must treat everyone who comes into the ER. So they have to charge some a lot to make up for the destitute who will never pay anything. If they were forced to take whatever low rates the insurance companies wanted to pay, how many docs would still be doing the ER work?</p>
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<p>Which is why we need to change them. If hospitals know that they will have to pay the bill for their ER docs if they turn out to be out of network, then the hospitals will stop contracting with out of network ER docs. If ER docs discover they can’t get a job without joining insurance networks, they’ll join insurance networks or accept direct employment with hospitals.</p>
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<p>How little faith you have in the market, TatinG. </p>
<p>RIght now, the hospitals and the ER docs are cooperating on a scheme to fleece unwary patients. The hospitals could just hire the ER docs on salary, but they don’t, because they know that it is more lucrative for the hospitals and the ER docs to swindle patients. We don’t have to put up with that. Nor do I propose that ER docs, or anyone, be “forced to pay whatever low rates the insurance company wants to pay.” They can say no. ER docs have a good deal of leverage, because one can’t have a hospital without ER docs, nor can one have an insurance plan without ER docs. And hospitals can employ ER docs directly-- many ER docs are employed that way now. Then the ER doc doesn’t have to worry about billing. </p>
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<p>Why? Right now, their charges are unlimited. They can charge the patient anything they want to, and the patient has no recourse other than a years-long lawsuit. Why would they accept limits?</p>
<p>My youngest kid had an ER incident when he was four involving a plumbing fixture that was stuck on his finger. We were there all night. They called a locksmith first to try to cut it off but he was afraid of slicing off the child’s finger. Understandably. Three or four physicians mostly stood around wondering what to do and looking at us with compassion until one doc came running in, took a look, and started laughing hysterically. He was the right guy. He numbed the finger and pulled the thing off and stuck his hand in a bucket of antiseptic solution which promptly turned bright red. The skin, he said, would grow back. The ER docs on staff were hopeless. We would probably still be sitting there.</p>