A sports injury leads to a big foul in medical billing
Miscommunication among healthcare players leaves a dad with a $6,000 MRI bill. After some prodding, Aetna does the right thing.
David LazarusJune 1, 2012
It's amazing how easily the smallest healthcare mix-up can spin out of control and leave the patient on the hook for thousands of dollars in medical bills.
In Jim Furlan's case, his journey into the healthcare Twilight Zone began in September when his then-15-year-old daughter injured her knee playing in a volleyball tournament in Las Vegas.
"She was rushed to the hospital in extreme pain," he recalled the other day. "They had to give her morphine."
The girl then flew home to Manhattan Beach, where her doctor ordered an MRI at Torrance Memorial Medical Center. It showed that she'd torn her anterior cruciate ligament, or ACL, a serious but not uncommon sports injury.
The next day, Furlan sought a second opinion from a prominent orthopedic surgeon, who confirmed the diagnosis. He scheduled an operation for about a week later, which Furlan's insurer, Aetna, readily approved.
So far so good.
http://www.latimes.com/business/la-fi-lazarus-20120601,0,3816087,print.column
One rural doctor decides to close shop: ‘It’s just not sustainable’
By Sarah Kliff,
A day in the life of Dr. Marc Shiffman can go something like this: Leave home at 7:45 a.m. Drive 40 miles through rural Colorado to Summit Internal Medicine, the clinic he founded in 2007. Start seeing patients at 8:30 a.m. Stop seeing patients at 5:30 p.m. Do paperwork—forms that need to be sent to insurers, bills that need to be looked over—until 9:15 p.m. Make the 40-mile drive back home. Arrive around 10 p.m. Repeat.Shiffman is the only internist in Summit County, a rural area of
Matt Cardy
GETTY IMAGES
Colorado about 72 miles west of Denver. He founded his own clinic in April 2007, after a long career working in large doctor groups and hospitals. At the end of this month, on June 30, Shiffman will close his clinic.
“In a word, I’d say running a solo, primary care practice in rural America is impossible,” Shiffman said. “Rural America is not well-served, and the prospects for the future are gloomier.”
Insurers, not insured, in driver’s seat
By Rep. Dennis Kucinich
The Hill, Congress blog, June 5, 2012
When the Supreme Court issues its decision on the Affordable Care Act (ACA), the debate will not stop. The ACA brought about immediate relief from some of the worst outcomes of for-profit health care, but it is by no means sufficient to temper the rapacious conduct of insurance companies who are determined to make money by not providing health care.
The Affordable Care Act prevented insurance companies from denying care to a patient who had a pre-existing condition like cancer or heart disease. It allowed young adults to remain on their parents’ family plan until age 26. It required that the kind of care that saves lives but is usually not profitable to cover — preventive care — is covered for free. It provided health care for tens of millions of Americans. It lowered the cost of prescription drugs for seniors. It gave states more authority to challenge exorbitant rate increases by insurance companies. It showed that the health care system can be reformed within the current health care model.
However, health care reform within the current health care model has glaring deficiencies. In the current model, insurance companies increase profits by not providing health care.
They avoid paying bills when their customers need health care. They compete by trying to invent creative ways to deny care, like providing complicated plans with large loopholes buried in the fine print that are only discovered if a person falls ill.
They also refuse to pay bills after care has been delivered, knowing patients often don’t have the time or strength to fight insurance company practices. For-profit health care has produced economic hardship for millions of Americans: it’s estimated 46 percent of all bankruptcies [PNHP note: a 2009 study showed 62 percent of all bankruptcies] are tied to medical bills piling up due to an illness in the family. Three-quarters of those bankrupted by illness were insured when they first got sick, which shows that the insurance policies did not pay the bills. It defeats the purpose of buying insurance.
People buy health insurance expecting that it will protect them from financial disaster. The for-profit model of “care” is fundamentally and inherently flawed.
http://www.pnhp.org/print/news/2012/june/insurers-not-insured-in-driver’s-seat
The Hill, Congress blog, June 5, 2012
When the Supreme Court issues its decision on the Affordable Care Act (ACA), the debate will not stop. The ACA brought about immediate relief from some of the worst outcomes of for-profit health care, but it is by no means sufficient to temper the rapacious conduct of insurance companies who are determined to make money by not providing health care.
The Affordable Care Act prevented insurance companies from denying care to a patient who had a pre-existing condition like cancer or heart disease. It allowed young adults to remain on their parents’ family plan until age 26. It required that the kind of care that saves lives but is usually not profitable to cover — preventive care — is covered for free. It provided health care for tens of millions of Americans. It lowered the cost of prescription drugs for seniors. It gave states more authority to challenge exorbitant rate increases by insurance companies. It showed that the health care system can be reformed within the current health care model.
However, health care reform within the current health care model has glaring deficiencies. In the current model, insurance companies increase profits by not providing health care.
They avoid paying bills when their customers need health care. They compete by trying to invent creative ways to deny care, like providing complicated plans with large loopholes buried in the fine print that are only discovered if a person falls ill.
They also refuse to pay bills after care has been delivered, knowing patients often don’t have the time or strength to fight insurance company practices. For-profit health care has produced economic hardship for millions of Americans: it’s estimated 46 percent of all bankruptcies [PNHP note: a 2009 study showed 62 percent of all bankruptcies] are tied to medical bills piling up due to an illness in the family. Three-quarters of those bankrupted by illness were insured when they first got sick, which shows that the insurance policies did not pay the bills. It defeats the purpose of buying insurance.
People buy health insurance expecting that it will protect them from financial disaster. The for-profit model of “care” is fundamentally and inherently flawed.
http://www.pnhp.org/print/news/2012/june/insurers-not-insured-in-driver’s-seat
New York Hospitals Look to Combine, Forming a Giant
By ANEMONA HARTOCOLLIS
Two of New York City’s biggest hospital systems reached agreement on Wednesday to pursue a merger that would shake up the way medical care is delivered, especially in Manhattan, where hospitals compete to serve some of the wealthiest neighborhoods in the world.
The proposed merger would bring together NYU Langone Medical Center, a highly specialized academic medical center, and Continuum Health Partners, a network of several community-oriented hospitals, including Beth Israel and the two St. Luke’s-Roosevelt campuses.
It would create one of the largest health care systems in the city, one that would have immense market power under the new federal health care system, and put pressure on independent medical practices, insurance companies and even rival medical schools, which may have to find other places to train their students.
The deal was outlined in a memorandum of understanding approved on Tuesday and Wednesday by the boards of both nonprofit organizations, and it is still subject to final confirmation by the boards. It would also need regulatory approval, and at least one patient advocacy group promised to challenge it.
By strengthening its competitive advantage, a merged hospital system could limit options for patients and charge more for services, advocates fear. It would also have more power to negotiate higher rates with insurance companies, which might be passed on to consumers in the form of higher premiums.
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