Last week, there was an interesting piece on the evening news. A child was bitten by the family dog and required the services of a plastic surgeon in the emergency room. The procedure went fine and the child and his parents returned home, unaware that the plastic surgeon that handled their case was not part of their insurance plan. The parents received a four thousand dollar bill for the physician's services.
A year ago, my brother drove the three miles to his local hospital after suffering chest pains. After determining that he did indeed have a serious heart attack, the hospital transported him via ambulance to their sister hospital, thirty minutes away for a cardiac catherization. Later that same month, he received a two thousand dollar bill for ambulance services!
There is a patient's bill of rights for all hospital treatment. This bill is usually standard for all patients and covers the rights to privacy as well as the right of the patient to allow or refuse treatment and to make decisions regarding this treatment or have them made by their health care proxy in cases where a conscious decision by the patient is not possible. The bill of rights also allows the patient to be treated by a physician that participates in their health care plan.
Now, we are all aware that emergency services are aptly named and none of us would want to wait for a participating physician in cases where emergency services are needed in a life or death situation. Someone who is having a heart attack is certainly not going to phone around town to find an ambulance company who participates in their plan, nor is someone who is bleeding going to call their insurance company to find a par physician to assure that no out of pocket expenses are charged.
Who should be responsible for situations such as those outlined above? Once again, we see case after case where those individuals who are actively insured and paying their premiums on time are still charged fees that may be a serious hardship for a working family. The hospitals would argue that the large number of uninsured or underinsured patients that come to the ER for treatment have posed a serious financial threat to their future survival. The insurance companies realize that past coverage that included a zero payment for ER services meant more and more individuals turned to their hospital emergency rooms to avoid any out of pocket expense. Now, most insurance plans have a deductible and or co-payment for ER services and expect the physicians who practice there to par with their plan. Patient bills for non par services often go unpaid, even after the most stringent collection efforts and are eventually written off as bad debt. This is just another example of why our health care system is overtaxed.
Perhaps hospitals and insurance carriers need to come to a better arrangement when it comes to emergency room coverage. Should a physician decide not to be a par provider with certain plans, then he or she should agree to provide coverage for 50% of the reasonable and customary fee for services. This would assure that patient's are not straddled with overwhelming hospital bills and still provide the physician with some form of reimbursement for their services.
It is not always the physician's choice not to participate in a particular plan. The insurance companies will often gauge the number of specialists in a demographic area and decide to close their panel when the area is adequately covered. Hospitals may not par or even drop a particular carrier if they feel the reasonable and customary fees are not enough to cover the expense of caring for the covered members.
In any case, the patient is the one who generally loses in the battle for coverage and the health care system in general also pays a steep price.
Will the new Obama plan help alleviate these problems? Once all citizens are covered, will doctors still receive an adequate fee that motivates them to continue to provide care? We know that by 2025, we will face a shortfall of physicians in the United States and cuts in reimbursement rates and the need to see more and more patients to make the same or less money than in past days is certainly a factor affecting the predicted shortfall. We may indeed face a future where students are hesitant to choose medicine as a career. We are regulating ourselves out of business just at the time where the largest population is going to be taxing the system even further. Once we de-privatize medicine and move toward a more socialized system, we will definitely see a change in the quality of care that our physicians provide and that we as patients have paid for our entire lives.
A year ago, my brother drove the three miles to his local hospital after suffering chest pains. After determining that he did indeed have a serious heart attack, the hospital transported him via ambulance to their sister hospital, thirty minutes away for a cardiac catherization. Later that same month, he received a two thousand dollar bill for ambulance services!
There is a patient's bill of rights for all hospital treatment. This bill is usually standard for all patients and covers the rights to privacy as well as the right of the patient to allow or refuse treatment and to make decisions regarding this treatment or have them made by their health care proxy in cases where a conscious decision by the patient is not possible. The bill of rights also allows the patient to be treated by a physician that participates in their health care plan.
Now, we are all aware that emergency services are aptly named and none of us would want to wait for a participating physician in cases where emergency services are needed in a life or death situation. Someone who is having a heart attack is certainly not going to phone around town to find an ambulance company who participates in their plan, nor is someone who is bleeding going to call their insurance company to find a par physician to assure that no out of pocket expenses are charged.
Who should be responsible for situations such as those outlined above? Once again, we see case after case where those individuals who are actively insured and paying their premiums on time are still charged fees that may be a serious hardship for a working family. The hospitals would argue that the large number of uninsured or underinsured patients that come to the ER for treatment have posed a serious financial threat to their future survival. The insurance companies realize that past coverage that included a zero payment for ER services meant more and more individuals turned to their hospital emergency rooms to avoid any out of pocket expense. Now, most insurance plans have a deductible and or co-payment for ER services and expect the physicians who practice there to par with their plan. Patient bills for non par services often go unpaid, even after the most stringent collection efforts and are eventually written off as bad debt. This is just another example of why our health care system is overtaxed.
Perhaps hospitals and insurance carriers need to come to a better arrangement when it comes to emergency room coverage. Should a physician decide not to be a par provider with certain plans, then he or she should agree to provide coverage for 50% of the reasonable and customary fee for services. This would assure that patient's are not straddled with overwhelming hospital bills and still provide the physician with some form of reimbursement for their services.
It is not always the physician's choice not to participate in a particular plan. The insurance companies will often gauge the number of specialists in a demographic area and decide to close their panel when the area is adequately covered. Hospitals may not par or even drop a particular carrier if they feel the reasonable and customary fees are not enough to cover the expense of caring for the covered members.
In any case, the patient is the one who generally loses in the battle for coverage and the health care system in general also pays a steep price.
Will the new Obama plan help alleviate these problems? Once all citizens are covered, will doctors still receive an adequate fee that motivates them to continue to provide care? We know that by 2025, we will face a shortfall of physicians in the United States and cuts in reimbursement rates and the need to see more and more patients to make the same or less money than in past days is certainly a factor affecting the predicted shortfall. We may indeed face a future where students are hesitant to choose medicine as a career. We are regulating ourselves out of business just at the time where the largest population is going to be taxing the system even further. Once we de-privatize medicine and move toward a more socialized system, we will definitely see a change in the quality of care that our physicians provide and that we as patients have paid for our entire lives.
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