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It is hard enough, in some cases, to simply find out if a provider is in network. Directories are not always updated, even online. My wife and I are on different plans, making it more complicated for us. Doctors and staff certainly don’t know; even when you call ahead, you can’t be certain of the answer you receive. My favorite is that every time you go to a provider, they ask for your insurance card, and I am dealing with a situation now where they STILL filed with an insurance provider I had (and they still had on file) from YEARS ago! What was the point of showing my card? The worst part is the provider (the ones who filed with the wrong company-THEIR mistake!) is now threatening to turn the bill over to collection because I refuse to pay it, even after I have given them the correct insurance info. To complicate this matter even further, the provider is my former cardiologist; so I am of the opinion that the bill is not legitimate in the first place! Everyone involved has passed the buck on this; the hospital blames the provider, the provider blames me, my insurance company has never received a claim, and I have yet to receive an itemized bill- just a demand for payment! What a screwed up system!
I forgot to add that the reason I was at the hospital was not related at all to any heart issues; that is why I don’t understand why my former cardiologist would be involved.
I am the President of a large anesthesia practice that provides exclusive services to Indiana University Health. We have a strong partnership with both the insurers and IU Health so that we are in-network with 100% of insurance companies so that, if you come to an IU Health facility in central Indiana, you will never get an out-of-network bill from your anesthesia provider. We know the devastating effects that an unexpectedly large bill will have on a patient whose sole concern should be recovery. I am fully in support of a bill to end surprise bills. However, such a bill without an independent resolution process (IDR) will significantly disadvantage the physician and decrease payments similar to what has happened in California. Without an IDR, the government will set the prices with a median benchmark and this favors insurance companies who can cancel higher paying contracts to artificially reduce the median. This goes very much against the free market system that, while imperfect in healthcare because of a lack of transparency, still has merits to provide a fair and balanced payment for services. So solutions at both the federal and state levels must utilize an independent system rather than arbitrary price setting to provide appropriate payments for services.
The whole concept of “networks” needs to be abolished. This is a scam perpetrated by insurance companies and Medicare to eliminate the options patients have to choose their physicians or hospitals. Think of your auto or homeowner’s insurance policy. If you have an auto accident, you are free to choose any shop to do your repairs including the most expensive option: the dealership (how many times have you heard stories of a minor “fender-bender” becoming 10s of thousands of dollars in repairs?). The auto insurance company is not allowed to tell you which shop to use. There are no “in” or “out” of network repair shops. If you have auto insurance, the company is obligated to pay the bill directly to the shop. Likewise for homeowners insurance. If you have a claim for water damage, snow, fire, etc., you are able to choose any electrician, plumber, framer, roofer, contractor, etc., you believe will do the best job (within your policy limits). The insurance company cannot tell you who to use. However, when it comes to your HEALTH, the insurance company WILL tell you who you can and cannot use for your care. You are not allowed to choose the best neurosurgeon, cardiologist, anesthesiologist, etc. The insurance companies contract with the lowest cost doctor to save the insurance company money and pay outrageous salaries to their CEOs. The American public for years has been so brainwashed into accepting the concept of health insurance “networks” that we no longer even question the concept. The insurance companies are now working tirelessly to convince our legislators of the same thing. The public needs to wake up and battle the “network” issue. If you have health insurance, you should be able to see any doctor or hospital you wish. Eliminate “networks” from health insurance. Your health (and life) are more valuable than car or house.
M.P.- Interesting that you chose to compare auto/homeowners insurance to health insurance. For years, I have wondered how auto insurance would work if it functioned like health insurance. You don’t pay your mechanic; you have him submit a claim. (After a while, you have no idea what basic services cost; you never really see a bill) You do get 4 “free” oil changes each year, a “free” tune-up every year, “free” tires every 2-3 years. Sounds great until you have a major repair; you still pay a $500-$1,000 deductible, and up to 20% of the remainder of the bill, and then your yearly premium could be anywhere from $300 to thousands of dollars, depending on any number of factors, only some of which of which you control. Of course, you still pay these premiums even if your car runs fine, and only needs routine maintenance, which you normally would have paid for anyway.
My point- I would love to have health insurance that only paid for a major medical event (I’ll take care of the routine stuff-flu shots, office visits for minor illnesses, yearly physical, etc) Quit telling me what I have to do, and when I have to do it, and quit giving me “free” stuff…it is costing me too much money!