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Congress Considers Consumer Relief To End Surprise Medical Billing

Untitled-design-6-300x300Congress is considering legislation to protect people with health insurance from receiving “surprise” medical charges. You know, the huge charges for receiving medical care out of your insurance company’s network. The proposed legislation would stop exorbitant and surprise emergency charges from out-of-network doctors and hospitals.

How Do Exorbitant Out-Of-Network Medical Charges Impact Alabama Accident Victims?

You have to laugh at some of the “legal” blogs ghostwritten by marketing people for law firms. They follow a formula. Step 1, express “horror” over some problem or injustice. Step 2, build-up the problem. Step 3, carefully avoid providing any information that would educate consumers. Otherwise, they may not call. Step 4, tell the reader he or she needs to call you as the keeper of solutions. Step 5, stuff the blog post with keywords that have nothing to do with the topic but may be important to your legal services. I disagree with this “formula.” I think blog posts should be authentic and should provide real information or opinions.

I recently read one such article titled, Surprise Medical Billing May Finally Be Ending. After calling the problem “horrific” for Alabama accident and injury victims, the marketer turns toward lobbying for calls to the law firm and listing search engine keywords that have little or nothing to do with the topic. Short on the key information. Long on the sales pitch.

What is the real scope of the problem? Let’s actually talk about it. According to the Kaiser Foundation, about 18% of emergency room visits led to an out-of-network charge. Keep in mind this percentage is nationwide. That’s important. Although a pretty small percentage, it still does not really get to the heart of the problem. If you live, work and suffer an injury in Alabama, you are probably going to an Alabama hospital for emergency treatment. If you have group health insurance through an employer, you are probably covered. Think about it — Blue Cross is (by far) the largest private health insurer in Alabama. The primary hospitals throughout Alabama are in its network. The other insurers typically have arrangements with local medical providers. Under these arrangements, your local hospital is likely in network.

Like most people, you may be upset by the high deductible. That’s definitely a separate issue we should all be discussing. But, you are probably in-network. You are not likely to face surprise out-of-network charges. Rather than “horrific,” we need to see that most people in Alabama will not face this problem.

The problem with surprise charges is much worse in densely populated areas. The problem is much worse in very large geographic areas. Why is that? Both are much more likely to have multiple private health insurers with different networks. The Kaiser Foundation notes New York and Texas have among the highest rates of out-of-network billing. That makes sense. If you remove these states from the math, the percentage should decrease. Again, if you live, work and suffer an injury in northern Alabama, your private insurance will likely cover medical care here.

The problem with surprise charges is also much worse if you are injured while traveling out-of-state. That’s the more likely scenario leading to a surprise out-of-network type charge for Alabama consumers. If you are traveling for work, then work comp may cover the accident and treatment. But, if you are traveling for pleasure and are hurt, you could face some out-of-network charge for emergency care.

I don’t write to downplay the issue. I believe we should fix the problem so nobody faces an unjust and surprise charge. I just think if we are going to dramatize the issue as a “horrific” worry, then we need to present more details for consideration.

Air Ambulances Are A Serious Cost Issue

The proposed legislation also addresses some issues related to air ambulance services. The charges for emergency helicopter rides are exorbitant. And, many of the air ambulance companies also harass injured patients for payment. If the helicopter carries you to the hospital, you will be shocked by the medical bill.

If you do a google search, you will find lots of articles discussing the issue with air ambulances.┬áLocal air ambulance companies easily charge $20,000.00 for flying a patient just across Madison County to Huntsville Hospital. Currently, Alabama only requires drivers to carry liability insurance coverage in the amount of $25,000.00. I’ve had several cases where the patient was severely injured by an at-fault driver with minimum limits, carried to the hospital by helicopter and then received a bill that would have consumed almost all the coverage. This is a serious issue that needs discussion.

Air ambulance services provide necessary life-saving transport for people with injuries that cannot wait for a regular ambulance. If you suffer a life-threatening injury in rural Alabama, you need a helicopter service that can carry you to a Level 1 trauma center like Huntsville Hospital. These services are very important. But, too often, these companies use their position to gouge excessive payments from hurt families. That’s wrong.

Open Networks Support Consumer Choice

We should be discussing greater fairness in medical billing. The current system is anti-patient.

The history of hospital liens in Alabama is one example of medical billing injustice. Until recently, hospitals filed liens against patients in personal injury cases to gouge them for exorbitant charges instead of filing on their health insurance. Imagine — You get hurt in a car accident, go to the local emergency room, give them your Blue Cross information and ask for treatment. You expect it to be OK. Instead of billing Blue Cross, the hospital files a lien on you. Keep in mind, the lien is for the full medical charges not the reduced rate your health insurer would have paid. That’s unjust for people who have health insurance. The Alabama Legislature fixed that injustice in the last couple years. If you want to understand hospital liens (which still gouge uninsured patients for excessive charges), you can read some of my past articles on this blog.

I understand the arguments from health insurers about controlling their hospital and physician networks. It’s not just health insurers who use medical networks. Pharmacy benefit managers (PBM) also create pharmacy networks. The problem occurs when these networks become anti-consumer or anti-small business. In the pharmacy world, some PBMs use their networks to drive business to favored pharmacies. That’s one reason independent pharmacies struggle against the large, favored chains.

The system should allow for greater patient choice. The system should provide greater billing transparency. The system should protect real competition among medical providers rather than favoring a few select large ones. All these issues need discussion if we want a system that protects working families.

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From its office in Huntsville, the Blackwell Law Firm represents people across Alabama in serious personal injury cases. If you have questions about a legal topic, let us know. We are happy to discuss legal issues or provide legal strategy. Our consultations are always free and confidential.

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