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Care to guess the odds of a surprise medical bill for an ER visit?

According to a study published in JAMA Internal Medicine, an employee’s odds of getting a surprise medical bill for an ER visit or a hospital stay exceed 40%!

Well, you might say, serves ’em right for not staying in-network.

Wrong. This study looked only at in-network visits and admissions. Thing is, in-network facilities are often staffed with out-of-network providers. I know this firsthand — I’m in a private equity fund that’s making a killing by rolling up provider practices in local markets and keeping them out of network. It’s illegal for provider practices to collude to stay out of network, but it is perfectly legal for them to merge and make a practice-wide decision to stay out of network.

So, wellness vendors and consultants, here are two opportunities you can’t refuse, that are both central to your business strategy:

  1. Actually do something useful for employees, as opposed to your usual scripted diatribes. Newsflash: employees already know they need to quit smoking and eat broccoli. But they don’t know how to avoid these bills.
  2. Prevent me from making money.

Also, this is the one thing that could bankrupt them that is totally avoidable. And yet your financial wellness program doesn’t cover it.

Fortunately, if you can spare one short hour on October 31 (which you will get back 38 hours later, when the time changes), you can learn how your employees can avoid these bills. All it takes is a little sticker to put on an insurance card and teaching employees to use their card, rather than sign whatever is put in front of them and/or say: “Same as last year” when they ask you if your insurance information has changed.

The all-star cast of this webinar includes David Contorno, Brian Klepper, Marty Makary, and Marilyn Bartlett. You can register here.

PS If you can’t make the time because of open enrollment, you’ll have access to the recording.

 

 

 

Surprise medical bill of the week: $650,000 for a $7000 operation

It’s not about the broccoli, folks.

The major hazard facing employees today is not a broccoli deficiency, but rather: surprise medical bills. And here is one that boggles the mind: $650,000 for a $7000 surgery.  Even when these emergencies are “covered” (meaning you pay their bill, except for the four-figure co-insurance), these bills create stress, both emotional and financial, far in excess of stress created by any problem that can be solved by eating more fruits and vegetables. The rate of these bills is also about 100 times the rate of diabetes admissions and heart attacks combined: more than half of Americans report receiving one in the last five years.

Further, people — even people who eat plenty of fruits and vegetables — live in fear of receiving one. Often one such bill can force a family into bankruptcy.

So perhaps it’s time to rejigger your wellness priorities in favor of this most pressing problem? And the other thing is, unlike risk factors (which rarely decline in a population by more than 1-2%, excluding dropouts anyway, according to the Health Enhancement Research Organization), this problem is solvable. Naturally, your wellness vendor has no clue how to solve it, so pay close attention to the following paragraph.

The “long version” of the solution can be found here, But if you don’t feel like clicking through to it, here is the short version: give your employees a sticker to put on their insurance card that says:

“I consent to appropriate treatment and to be responsible for reasonable charges not covered by insurance, up to 2 times the Medicare rate.”


Then you need to educate your employees — using Quizzify or an endless stream of memos, as you prefer — to do two things:

  1. Carry the insurance card and show the insurance card. It’s not enough to say: “Oh, yeah, I’m covered by so-and-so,” and have the intake person verify eligibility.”
  2. Do not sign the “terms and conditions” they thrust at you. That boldfaced sentence above contains the consent language needed. They have to treat you, based on that consent.

Unlike attempting to create a more broccoli-centric workplace, this is exactly the type of behavior change you can get widespread acceptance of. Nothing like the threat of bankruptcy to motivate employees to put a sticker on their insurance card.

 

 

 

 

 

 

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