This is truly a great improvement, but not including ground ambulances in this is messed up. And reeks of a special-interest lobbying group pushing for it.
This also really bothers me:
> Out-of-network doctors also must inform patients about what their care might cost, and they may ask patients to sign a form that waives their protections. (Be leery of signing this, consumer rights experts say.)
It's a very weak law when you can still sign away your rights to someone who has the stronger end of a power/information imbalance. Emergency care is supposed to be covered by this law, but if you're in bad shape and show up at the ER, you might sign anything just to get care.
My wife went into anaphylaxis at an urgent care facility. The doctor there administered an epi and then called 911 to get an ambulance to the nearest hospital.
We ended up getting a >$2,000 bill for a 10 minute ambulance ride because the ambulance company was out-of-network. The ambulance company then had the audacity to send the bill to collections before the 30 day pay period even expired...
So yea, even if you have good insurance you can still get bit by these issues in emergencies! Unfortunately, this new bill does not even address the out of network ambulance issue.
Actually - this is an effort to bring the free market into the system. Ie, doctors have to tell you UP FRONT what they will charge you, and cannot just drop by your room while you are out and then bill you for the evaluation.
You can then decide if the specialist out of network is worth it, or go in-network or to your medical / medicare provider and work with them.
In particular (for those who don't know) California's law protects you ONLY if you go to an IN NETWORK facility. If you do, then if somehow an out of network doctor drops by or helps with the knock out gas or whatever, they can't then bill you for the "out of network" service. It turns out this was pretty common (my guess is some kind of kickback to the in-network facility to allow this).
You can still be charged or over charged by any provider if you agree to be, and sometimes still even if you don't (ambulance ride to out of network)
"Here's a sensible solution: when it comes to emergency-based care, insurers must accept all comers as in-network. There's no such thing as "out of network" emergency-related care."
I actually agree. And to make this work insurers should stop negotiating individual rates with providers and instead providers should have a set price they charge no matter who pays. It's nuts that if you don't have insurance you pay 30k but with insurance suddenly the provider is OK with 7.5k.
So for any kind of emergency care they are not allowed to "gotcha" with out of network providers at in network hospitals, this has always been the case. However, according to my quick Google research apparently anything else is state-law dependent so what I said doesn't apply equally in the country.
Hopefully they have a plan for a better mechanism to discourage frivolous ambulance calls and ER visits. Those resources are overloaded by casual abuse resulting in higher costs and wait times for those who truly need emergency care. Without an alternate disincentive that problem will only get worse with this change.
It does if you don't have an EPO (like say, most grad students) and you end up with an emergency at a out-of-network hospital. How plans like EPOs are legal baffle me every day.
Even 20 years ago, I experienced this directly as someone who paid for their ER care while others came in for non-ER care, and knowing they would not have to ultimately pay for the care they received.
Honestly, I appreciate reading about your experiences, and bottom line, I'm happy that you're able to access medical care.
Your experience hints at some of the flaws in US healthcare:
> For ER care individual doctor ratings are unimportant, because you have no idea who the doctor will be.
Right, and if the ER doctor you happen to draw is out of network for you, RIP your savings and/or credit score. Isn't this a decently common problem, where even an "in-network" institution employs practitioners who are "out of network" for you, so you thought you were covered by your insurance company's rules, only to be surprised days after treatment?
EDIT: this "out-of-network provider at an in-network institution" problem was so common and frustrating that Congress has had to ban the practice, as linked in the article: https://archive.is/50VQv
> take me to the ER of my choice (that is, my insurers choice)
Leaving the choice of ER to one's insurer doesn't sound like my idea of "free market" healthcare. What if they choose your area's "bad" ER? I suppose you can indirectly pre-choose your ER by choosing an insurer which covers the ER of your choice -- that is, unless you get insurance through your employer, in which case I guess you'd have to purchase private coverage for your ER of choice.
Different institutions have different reputations in single-payer publicly funded health systems too, so I'm not so sure if that's the crux of the matter. What upsets me is that those people who are in the most desperate need of healthcare are almost by definition in the worst possible position to make an informed choice. Picture an unconscious victim of an accident, violence, stroke, heart attack, etc. Oh, and it seems generally impossible for even an awake and alert person to "shop around" by comparing price quotes for the healthcare they need, preventing competitive choice.
Then there's the issue that ERs must stabilize and treat anyone who enters, regardless of ability to pay. Someone has to cover the cost of this.
What kind of "market" keeps prices secret from incapacitated consumers? I think MereInterest summed it up perfectly: The nature of medical emergencies prevents actual markets.
This doesn’t contradict your post (and perhaps even reinforces it) but it’s important to note, ambulance rides are required to be covered as in-network by your insurance, though billing you that way isn’t! That is a single ambulance ride should top out your out of pocket coverage on any legal insurance plan. If your bills or insurance say otherwise they are likely paying fast and loose with the rules.
Every time I read an article like this I end up baffled. I don’t live in the US (or Europe) and even in this part of the world I know that my health is taken care of. I might get a higher bill by choosing a private clinic to get a single room or a hotel-like experience, but if I choose to I can pay zero for a broken arm or even heart surgery. If the ambulance is closer to a private facility, then there’s where I am taking to, I’m not paying extra for that.
I've had doctors in the ER bill directly out of their own practice several times. Out of network, but I've had no choice in the matter except to receive treatment or refuse treatment for life-threatening conditions.
Florida typically comes dead-last consumer protection-wise except that it requires ER physicians to be "in-network" when the hospital is also "in-network".
>I'm surprised that they didn't include a motion to declare the contract invalid on the grounds of duress.
success of such motion would destroy all the "pay for the service" system as you do agree to pay for the service before it is rendered - otherwise the doctor willn't provide the service. To my understanding the ER is the only place where medical care muct be rendered without any pre-condition of entering into any contract.
The out of network care at an in-network hospital, is the absolute worst. In a similar vein, my wife's insurance was supposed to cover "out-of-network" ER visits. So one night that we had to go the ER we went to an out-of-network hospital ER because there wasn't an in-network one close by. Turns out that the coverage of the out-of-network ER visit basically just covers the cost of the bed in the ER, every treatment that you get (IV, vitals check, medication) is considered out-of-network treatment. This resulted in an absolutely insane bill with charges like $250 for administering oxygen monitor (you know the things you can buy at Wallgreens for $30) or $300 for ibuprofen.
I agree in theory, but I fear it's incompatible with ubiquitous emergency care. If someone collapses on the street, I don't want paramedics refusing care because they don't know if the person has opted out.
This also really bothers me:
> Out-of-network doctors also must inform patients about what their care might cost, and they may ask patients to sign a form that waives their protections. (Be leery of signing this, consumer rights experts say.)
It's a very weak law when you can still sign away your rights to someone who has the stronger end of a power/information imbalance. Emergency care is supposed to be covered by this law, but if you're in bad shape and show up at the ER, you might sign anything just to get care.
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