California Supreme Court: Doctors cannot bill patients

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BlackSails
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California Supreme Court: Doctors cannot bill patients

Postby BlackSails » Sun Jan 18, 2009 6:22 am UTC

http://online.wsj.com/article/SB123147400201867391.html

California's high court ruled that emergency-room patients can no longer be billed by doctors and hospitals for care that isn't fully paid by their health plans.

The court on Thursday struck down a practice known as "balance billing," in which doctors and hospitals seek to collect from patients any amounts that their managed-care plans refuse to pay. Instead, the providers must either absorb the costs themselves, or get the insurance companies to pay.

Balance billing is controversial because patients are sometimes hit with emergency-room bills because they go to the nearest hospital or other medical facility regardless of whether it accepts their insurance. Health-care providers argue that they need some way to guarantee that they can be paid for their services.

In its decision, the California Supreme Court overturned a lower-court ruling and found that billing disputes over emergency medical care must be resolved solely between providers and health plans.

Connecticut, Pennsylvania and Alabama also have banned balance billing, according to the California Department of Managed Health Care.





As a result of this ruling, an Emergency Physician
1) cannot refuse to see a patient
2) cannot bill the patient directly
3) must either work out a contract with the insurance company ahead of time or sue the company for the difference between bill and payment.
3a) has no bargining power with the insurance company
3aa) The costs of a lawsuit will far outstrip whatever payment is owed.



Now balance billing isnt the greatest practice in the world. <s>A patient going to the emergency room</s> Some patients going to the emergency room really do not have the time to search around for a doctor who accepts their insurance or a hospital that is "in network." I can ask a plumber for a quote on how much a repair will cost, but I cant exactly ask the same from an EP.

However, this puts doctors in the unenviable situation of having nobody to bill for their services. Sure, they can bill the insurance companies (who use fraud to lower payments) but as mentioned above, they have no barginging power at all. (And no, the large majority of doctors, since they are technically all independant contractors cannot unionize due to anti-collusion laws)

How can this problem be fixed?

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Re: California Supreme Court: Doctors cannot bill patients

Postby mazzilliu » Sun Jan 18, 2009 6:26 am UTC

maybe they can use class action lawsuits to cut down on lawyer fees?

also, i'm predicting everyone will use the emergency room for everything from now on in california.
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Re: California Supreme Court: Doctors cannot bill patients

Postby BlackSails » Sun Jan 18, 2009 6:30 am UTC

mazzilliu wrote:maybe they can use class action lawsuits to cut down on lawyer fees?


Class action lawsuits dont really cut down on lawyer fees. Its been said that the only winners in a class action lawsuit are the lawyers. For both sides.

also, i'm predicting everyone will use the emergency room for everything from now on in california.


They already do. People use the emergency room for things like "my butt is sweaty", "My child threw up. Once.", "I have a hair on my chin and I want you to give me something to make it go away", etc

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Re: California Supreme Court: Doctors cannot bill patients

Postby mercurythief » Sun Jan 18, 2009 6:57 am UTC

An article with a bias for the other side of the issue:

http://www.businessweek.com/magazine/content/08_36/b4098040915634.htm

I do think that making balanced billing illegal is a hilariously bad idea, though.

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Re: California Supreme Court: Doctors cannot bill patients

Postby Soundwave Guy » Sun Jan 18, 2009 7:43 am UTC

And here's an article that shows that this isn't "news" because it came out nearly ten days ago (WSJ must be a little far behind...)

http://www.fox40.com/pages/landing_loca ... feedID=190
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Re: California Supreme Court: Doctors cannot bill patients

Postby LeopoldBloom » Sun Jan 18, 2009 7:56 am UTC

Sounds like a good idea, in an ideal world it would of course be free, but this is a good compromise. When I cut my hand of with a chainsaw I don't want to worry if I can afford treatment and the insurance will cover it. But then that's just me, I still wonder why Americans don't have a NHS.
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Re: California Supreme Court: Doctors cannot bill patients

Postby Gelsamel » Sun Jan 18, 2009 8:08 am UTC

Uh, what the fuck? Seriously? I donno about in the US but in Aus the hospitals have trouble with funding/doctors/beds etc. so they need every bit of coin they can get their hands on.



Preface: I have no idea how all the insurance stuff works, at all.

However, wouldn't a GOOD plan cover anywhere you're likely to be hospitalised? And thus it's the patients fault for getting a sucky ass plan. What about people who have no insurance at all and they go to emergency? It's essentially the same thing.

I could possibly be misunderstanding this whole billing thing though.
Last edited by Gelsamel on Sun Jan 18, 2009 8:09 am UTC, edited 1 time in total.
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Re: California Supreme Court: Doctors cannot bill patients

Postby Sharlos » Sun Jan 18, 2009 8:09 am UTC

The better question is why their insurance doesn't cover the complete costs of emergency treatment.

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Re: California Supreme Court: Doctors cannot bill patients

Postby Malice » Sun Jan 18, 2009 9:32 am UTC

Gelsamel wrote:Preface: I have no idea how all the insurance stuff works, at all.

However, wouldn't a GOOD plan cover anywhere you're likely to be hospitalised? And thus it's the patients fault for getting a sucky ass plan.


I believe the way insurance works is, because the company is paying for the health care of many many people, they are basically one of the hospital's biggest "customers". So they negotiate the prices of various procedures with the hospitals, and can throw their weight around and get discounts. However, they have to do this for each hospital (I think) and depending on the results, they decide to only work with particular hospitals where they get the best deals. Basically it's a choice for them between paying more to insure treatment at all hospitals and forcing the extra work on the patient of finding an "approved" hospital, even if they may be in an emergency situation. So basically the customer gets shafted, and now apparently the doctors get shafted too.
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Re: California Supreme Court: Doctors cannot bill patients

Postby Pizzashark » Sun Jan 18, 2009 10:57 am UTC

Sharlos wrote:The better question is why their insurance doesn't cover the complete costs of emergency treatment.


Because insurance companies make money by taking your money, not spending it :P

Having had to go to the ER recently, and being uninsured, I like the idea of not having to pay hospital bills (for the record, my bill comes to about $1,300 between facility costs and physician's fee... those $300 Ace bandages are killers.) But at the same time, I really don't like the idea that the hospital might be forced to absorb the cost of the treatment. Suturing up a relatively minor laceration and sending someone on their way is one thing, but the costs involved in fixing someone who was involved in a major carwreck are guaranteed to be enormous, and that's not even counting the doctors' payroll. This is just for people who are uninsured, though.

If they're insured, the insurance companies should shut the fuck up and pay the bills.
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Re: California Supreme Court: Doctors cannot bill patients

Postby EmptySet » Sun Jan 18, 2009 11:25 am UTC

So if you had an insurance plan which only covered treatment in a tiny hospital somewhere in darkest Alaska, you could go to ER all over the country without anyone ever having to pay the doctors? That seems utterly ridiculous.

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Re: California Supreme Court: Doctors cannot bill patients

Postby Soundwave Guy » Sun Jan 18, 2009 11:31 am UTC

EmptySet wrote:So if you had an insurance plan which only covered treatment in a tiny hospital somewhere in darkest Alaska, you could go to ER all over the country without anyone ever having to pay the doctors? That seems utterly ridiculous.


Well, sort of. The idea is that insurance companies become more accountable for paying the debts owed to the doctors, which is...you know, why you have insurance in the first place...

And I'm not sure you can go to the doctor "all over the place," pretty sure this only applies in California. But I could be wrong.
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Re: California Supreme Court: Doctors cannot bill patients

Postby Metacelsus » Sun Jan 18, 2009 11:39 am UTC

On the one hand it's detrimental to patient health (and therefore to society as a whole, my opinion anyway) to make cost a concern in an emergency situation on the other hand making the hospitals eat the cost isn't the answer, a service is being provided here and you have to pay for that somehow.

The fact that they are forcing the hospitals to foot the bill and not the insurance companies speak volumes about that industry's lobbying power.

One solution would of course be to have the tax-payer fund emergency service at all hospitals so people only need insurance for more serious and ongoing treatment when it is more reasonable that they can choose their care provider but of course that would be a form of universal healthcare which is an evil commie idea.

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Re: California Supreme Court: Doctors cannot bill patients

Postby Pizzashark » Sun Jan 18, 2009 11:42 am UTC

Last thing anyone needs are more taxes, but it's a reasonably good idea.

Still think it should be the insurance companies footing the bills, not the insured.
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Re: California Supreme Court: Doctors cannot bill patients

Postby Gelsamel » Sun Jan 18, 2009 11:44 am UTC

Some Asshole wrote:Last thing anyone needs are more taxes, but it's a reasonably good idea.

Still think it should be the insurance companies footing the bills, not the insured.


But the insured will have to pay for it since they'll end up having to pay the insurance companies more to cover costs anyway.

Edit: Anyway wouldn't there be more expensive insurance policies that allow higher coverage anyway? Wouldn't that still mean it comes down to what policy you chose? Or do insurance companies not offer different types of policies with higher/lower coverage and literally say "Yeah we're basically not going to deal with that hospital at all"?
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Re: California Supreme Court: Doctors cannot bill patients

Postby Soundwave Guy » Sun Jan 18, 2009 11:46 am UTC

Some Asshole wrote:Last thing anyone needs are more taxes, but it's a reasonably good idea.


I'm all for the unpopular idea of higher taxes. Anyone notice that the places of the world with higher taxes generally have better socialized programs and tend to have overall happier people?

Example: Britain, France, Germany -- some of the highest-taxed places in the world. And while they may have corrupt politicians (what country doesn't?), the amount of lobbying and corruption can't even touch the amount that is felt in the United States. Plus, there's no instances of "It's all mine, it's all for me!" It's more or less a feeling that everyone helps everyone.
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Re: California Supreme Court: Doctors cannot bill patients

Postby Metacelsus » Sun Jan 18, 2009 11:55 am UTC

Some Asshole wrote:Last thing anyone needs are more taxes, but it's a reasonably good idea.


The way it works over here (Aus) is that there's universal healthcare which is paid for out of income tax (not sure but off the top of my head I think it's a sliding scale based on income that tops out at about 1 or 1.5k a year). But obviously the public system is very busy and so for any complicated or long term or non-emergency treatments you're likely to encounter a waiting period. So we also have insurance companies which will pay for you to go to private hospitals (as well as getting you extra stuff in public hospitals) which generally have nicer rooms, more doctors/patient etc. and if you have private coverage you get some or all of your medicare levy (the tax that pays for public hospitals) refunded.

So everyone is covered but if you want nicer or faster service you can pay for it. The other subtle thing this does (and the main reason I like it) is it provides a baseline that insuance companies have to compete with. My understanding in the US at the moment is that insance costs are pretty ridiculous but since people don't have any other option (if you get sick you NEED it) people have to pay it. Over here people don't have to get insurance if they don't want to but can still be assured they'll be taken care of if something happens to them, just maybe not to as high a standard as they could have otherwise. This puts more pressure on the insurance companies to actually offer a valuable product.

My other argument would be that if you have a healthy workforce they're going to be able to work more and therefore provide more in taxes and so the overall cost could therefore be lower, all other things being equal.

While I'm on a rant my other understanding is that because of high insurance prices most people have coverage through their employer who get better prices due to bulk service etc. I'm not sure there is a difference between taking insurance as part of your salary package and paying for it out of income tax, it's still coming out of your wage, just at a different point. Of course I ssuppose the idea is to give people the option of not being covered at all but I'd be interested to know how many people that is (who choose to be uninsured, not who simply can't afford it).

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Re: California Supreme Court: Doctors cannot bill patients

Postby BlackSails » Sun Jan 18, 2009 3:44 pm UTC

I think a good solution would simply to allow doctors to unionize.

One doctor telling an insurance carrier (say, United FraudCare) "screw you, im not going to participate with your plans" does nothing.

If all the doctors in a state say so, now the insurance carrier has to engage in some bargining.


Doing so would require rewriting the anti-trust laws though, so its never going to happen.

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Re: California Supreme Court: Doctors cannot bill patients

Postby Xeio » Sun Jan 18, 2009 5:28 pm UTC

So, are hospitals required to have emergency rooms? Because I could see them closing them really fast if they can't properly pay for them.

I can't help but think of Jennifer Government, where when you call 911, the first thing they ask you for is your credit card number to check your credit...

EDIT:

Ok, holy crap. http://en.wikipedia.org/wiki/EMTALA. Though it does seem hospitals are required to provide some 'minimal' service, whatever that means.

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Re: California Supreme Court: Doctors cannot bill patients

Postby Freakish » Sun Jan 18, 2009 5:47 pm UTC

I think that there's a saying about money and trees that needs to be emphasized here.
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Re: California Supreme Court: Doctors cannot bill patients

Postby Indon » Sun Jan 18, 2009 8:51 pm UTC

I can't help but think that medical insurance companies have a hand in this decision.

Given the choice between forcing one of two groups to pay for patient care, they chose the group whose job is not to pay for patient care, versus the group which exists solely to pay for patient care.
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Re: California Supreme Court: Doctors cannot bill patients

Postby The Reaper » Sun Jan 18, 2009 10:51 pm UTC

ITT: Hospitals collapse due to lack of funding.

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Re: California Supreme Court: Doctors cannot bill patients

Postby clintonius » Sun Jan 18, 2009 11:00 pm UTC

Gelsamel wrote:Anyway wouldn't there be more expensive insurance policies that allow higher coverage anyway? Wouldn't that still mean it comes down to what policy you chose? Or do insurance companies not offer different types of policies with higher/lower coverage and literally say "Yeah we're basically not going to deal with that hospital at all"?

It's always possible to go get your own insurance and pay as much as you wish for the extent of coverage you wish. However, in my experience, your choices among employee-sponsored insurance plans are limited. Considering that the vast majority of people in this country presumably can't pay for a top-level insurance plan completely out of their pocket (many sponsored plans still run hundreds of dollars per month), it's not really accurate to say it comes down to which plan you choose. I don't believe I've encountered a single insurance plan option through my employers that provides for full payment at absolutely any treatment facility, and I've worked for both a law firm and as a teacher employed by the municipal government. Both of those employers offer relatively excellent insurance plans. So, in practice, it's really not feasible for many people to get insurance that will pay for treatment regardless of where it's received.
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Re: California Supreme Court: Doctors cannot bill patients

Postby EsotericWombat » Mon Jan 26, 2009 10:27 pm UTC

To the people who are saying that the insurance company lobby had anything to do with this: This is the COURT that made the decision.
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Re: California Supreme Court: Doctors cannot bill patients

Postby Indon » Tue Jan 27, 2009 4:09 pm UTC

I never said I thought the insurance companies had a legal influence on the decision.
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Re: California Supreme Court: Doctors cannot bill patients

Postby 22/7 » Tue Jan 27, 2009 4:13 pm UTC

What a terrible idea. Why would anyone in California get health insurance or use a regular doc?
Totally not a hypothetical...

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Re: California Supreme Court: Doctors cannot bill patients

Postby Bakemaster » Tue Jan 27, 2009 4:16 pm UTC

Gelsamel wrote:wouldn't a GOOD plan cover anywhere you're likely to be hospitalised?

If there is such a thing as a "good" health care plan in this country, it's either hideously expensive or a perk of an exceptionally good job.
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Re: California Supreme Court: Doctors cannot bill patients

Postby Indon » Tue Jan 27, 2009 4:56 pm UTC

22/7 wrote:What a terrible idea. Why would anyone in California get health insurance or use a regular doc?


Individuals who are relatively well-off could go with preventative medicine.
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Re: California Supreme Court: Doctors cannot bill patients

Postby Plasma Man » Tue Jan 27, 2009 5:14 pm UTC

Wouldn't a good solution be to put an extra tax on the insurance providers? The money from this would then be put into an earmarked fund that would be used to compensate hospitals that lose out from balance billing being abolished. Yes, the insurance companies would probably pass the cost on to their customers, but that seems like a better option than hospitals being bankrupted.
Anyway, the idea that you should choose which hospital to go to in an emergency is ridiculous. If you're unconscious or otherwise unable to communicate, you have no control over where you get taken, so it seems a bit unfair to screw you with a huge bill for that.
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Re: California Supreme Court: Doctors cannot bill patients

Postby Iv » Tue Jan 27, 2009 5:24 pm UTC

Soundwave Guy wrote:I'm all for the unpopular idea of higher taxes. Anyone notice that the places of the world with higher taxes generally have better socialized programs and tend to have overall happier people?

Example: Britain, France, Germany -- some of the highest-taxed places in the world.

While it is not exactly happy candy land here either, I must say that going to the doctor and using the health card (functionally an ID card that identifies you as a citizen and that could do with a bit encryption) instead of having to pay is great. Then going to the pharmacy with the doctor note and getting a dozen of drugs without paying anything is really comfortable. In fact it helps making you go see the doctor at the beginning of a health problem instead of letting it go that is statistically more costly to the society as a whole.

It is strange that in US an insurance company can call a contract "healthcare" is it doesn't work in every hospital or that an hospital can be call such if it refuses some healthcare contracts. Wouldn't it be a job for the state to mandate some standard ?

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Re: California Supreme Court: Doctors cannot bill patients

Postby 22/7 » Tue Jan 27, 2009 5:56 pm UTC

Indon wrote:
22/7 wrote:What a terrible idea. Why would anyone in California get health insurance or use a regular doc?
Individuals who are relatively well-off could go with preventative medicine.
Well sure, you could do lots of things, but if the alternative is free, only the very wealthy will take the comparatively expensive option.
Totally not a hypothetical...

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