You don’t owe the hospital/doctor what insurance won’t pay?

One of the things that really bugs me is how complicated, messy, and time consuming dealing with health care bills are. I work for a company with one of the nation’s best coverages (almost no copays on anything) and I’m in generally good health - and still looking at EOBs, doctors invoices, etc for my wife and I confuse the crap out of me. I can only wonder how this is for most other people!

Here’s today’s shocker, courtesy of my fav blog consumerist:

Medical Bills You Shouldnt Pay
As health-care costs continue to soar, millions of confused consumers are paying medical bills they dont actually owe. Typically this occurs when an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid. The health-care provider demands the balance from the patient. Uncertain and fearing the calls of a debt collector, the patient pays up.

Most consumers dont realize it, but this common practice, known as balance billing, often is illegal. When doctors or hospitals think an insurer has reimbursed too little, state and federal laws generally bar the medical providers from pressuring patients to pay the difference. Instead, doctors and hospitals should be wrangling directly with insurers. Economists and patient advocates estimate that consumers pay $1 billion or more a year for which theyre not responsible.

Amazing! This is almost as odious as the fact that doctors and hospitals are now offering credit cards and upselling patients on services. I love this quote:

As some authorities get tougher, physicians are trying to overturn prohibitions on balance billing. The American Medical Assn. is lobbying Congress to allow balance billing within the Medicare program, as was allowed until 1991. Two Republican congressmen, Tom Feeney of Florida and Tom Price of Georgia, have sponsored legislation that would accomplish that goal. The AMA cites declining reimbursements from Medicare and private insurers in support of its bid to bill patients directly. AMA member David McKalip, a neurosurgeon in St. Petersburg, Fla., says patients can trust doctors to behave ethically and not gouge the poor: “Doctors will know up front which patients are willing to pay” beyond what the government reimburses.

Seriously? I love this counter example:

The case began in December 1995, when Siglinger’s wife, Laura, and his daughter, Allison, then three, were injured in a car accident. Both were taken to the emergency room at Bridgeport Hospital, where Dr. Charles Gianetti, the plastic surgeon on call, stitched a cut on Allison’s face. The Siglingers’ insurer paid Gianetti $1,981 under a contract with the family’s health plan. Later in 1996, he claimed the Siglingers owed him an unpaid balance of $4,496. The Siglingers refused to pay, and Gianetti sued them. Ruling for the Siglingers, the trial judge ordered Gianetti to pay their legal fees, in addition to the punitive damages. The Siglingers say he hasn’t paid them anything.

“It was traumatic enough seeing my daughter go through a serious accident, but then to go through this,” says Siglinger, a real estate investor. He and his wife have since divorced; Allison is now 15. “I wonder how many people paid these bills without giving it a second thought,” he says. The Siglingers are among 150 patients Gianetti has sued for unpaid balances, according to state records. The Connecticut Attorney General’s Office is scheduled to go to trial next year against Gianetti, having accused him in a civil suit of improper billing.

Gianetti, 69, no longer practices medicine, but he continues to pursue former patients in court. He says the state of Connecticut has “nothing on me,” declining other comment.

I don’t pretend to have any solutions for fixing our health care solution. And I’m keenly aware that the solutions in other countries have their own pros and cons - but it just seems to me that we really ought to be able to do better than the status quo.