Before continuing with this posting, we would like to acknowledge the heroic efforts of frontline healthcare workers, risking their own health and even lives to save others. These are not the people sending the bills. That would be the private equity-controlled hospitals and specialty groups. it is important to draw a bright line between these cohorts.
You might have read somewhere that surprise bills are not allowed by hospitals taking funds under the CARES Act. This is true. The patient share is limited to what they would have paid in-network.
So who do you think is paying that bill? Look at the person six feet to your left. Now look at that person six feet to your right. All three of you are.
This bill isn’t a price control for out of network providers. The bills don’t automatically get lower. Only the patients are protected. This actually makes surprise-billing much easier, because the employee is not likely to complain if it’s not their bill. Who even reads the EOB? How many employees even know wht EOB stands for?
Recently DirectPath released a report called the Health Care Literacy Gap. In it, they noted that 55% of employees already don’t complain about billing errors, because they don’t feel it’s worth the effort.
Why don’t they feel it’s worth the effort? Let’s put it this way: when was the last time you didn’t complain about a billing mistake at a restaurant, hotel, etc. ?(Yes, we know it was more than a month ago. We are being figurative here.) That’s because it’s your money.
But if the waiter or hotel manager came over and, instead of presenting a bill, said the whole thing was on the house? Would you ask to review the bill and point out mistakes? And that’s exactly what could happen if patients are held harmless from out-of-network charges due to COVID.
COVID treatment should be free in any case. But if you read the CARES Act closely, it appears that even patients testing negative who are then treated for something else may be immune from surprise bills. Once again, who do you think is paying?
And you can bet there will be more of them than ever in 2020. That’s because the private equity companies are counting on the facts not just that employees won’t complain, but that your overall healthcare spend will be way down…and as a result you won’t carefully review your individual charges.
This of course doesn’t include the surprise bills employees will get as a result of other emergency visits, admissions, and deliveries. Heart attacks aren’t going away.
Fortunately, there is a solution. You can implement it posthaste. It’s all wrapped up in this podcast. The podcast features not only me, but uberbroker David Contorno, ERISA guru Doug Aldeen, and Rachel Miner, who in addition to being a successful broker, actually had the unfortunate chance to have to use our surprise bill “hack” in a North Carolina emergency room. North Carolina provider are notorious for their high-multiple-of-Medicare pricing, but this hack you’ll be hearing about kept her bill to a paltry 2x Medicare, including for any out-of-network “ologists” consulting on her son’s case.