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Avoiding Medical Bankruptcy: the Ultimate Health Equity Victory

Updated: Nov 9, 2021


This is Part One of a Two-Part Series

If one issue exemplifies health equity, it’s the cost of healthcare itself and the differential impact of it on your hourly employees. They say you’re not supposed to start a blog post with statistics, but these statistics are too important to ignore:

Many of those employees could be yours. Indeed, overcoming the threat and fear of medical bankruptcy could be the #1 health equity issue your company faces, and one of the top stress issues as well.


Nonprofits that raise money to pay off medical debts may possibly dent this problem for your employees who already have bills in arrears, but Quizzify can help you put a major dent in onerous medical bills, and fears of those bills, going forward.


That’s because, uniquely, Quizzify is doing something about high medical bills. Specifically, our ER Sticker Shock Prevent Consent “solves” this problem. “Solves” is in quotes for two reasons:


1. We can’t make the problem go away, and

2. The Quizzify Prevent Consent doesn’t apply to elective care.


But we can make the emergency care billing problem kinda sorta go away. Let’s put it this way. While you probably can’t remember the last time you saw an allowed ER claim with fewer than four figures, we can and do guarantee (for our customers) that these 29 words in the Quizzify Prevent Consent keep virtually 100% of ER bills in the three figures:


"Superseding other consents, I consent to responsibility (including insurance) for up to 2x Medicare following receipt of an itemized bill for appropriate treatment coded at the correct Level."


Likewise, you probably rarely see an allowed emergency admission claim that didn’t have at least five figures. We contractually guarantee that the large majority, though far from all such admissions, will be in the four figures. This includes COVID admissions.


The differences in the deductibles and co-pays for those emergency bills, well into the hundreds or thousands of dollars, are the differences between belt-tightening and financial hardship for many if not most of your hourly employees.


Talk about health equity!


Why the Quizzify Prevent Consent Works


By way of background, here's how/why the Quizzify Prevent Consent works. In 1986, a federal law was passed, the Emergency Medical Treatment and Active Labor Act (EMTALA), to prevent hospitals from “dumping,” as it was called back then. After 1986, hospitals could no longer turn away patients based on ability to pay. Instead, they had to treat every emergency visit, delivery and admission that came in the door.


In the case of emergency visits, there should no longer be, and generally no longer is, any difference whatsoever in treatment based on ability to pay. Once inside the facility, the treating physicians and nurses have no way of knowing who is paying what. And it would be illegal for them to treat people differently if they did know.


In the case of admissions, EMTALA doesn’t require the hospital to keep a patient for the entire stay whose payment method they don’t like. Once the patient has been stabilized, the patient could be transferred. EMTALA also allows transfer for ER visits following stabilization and for emergency deliveries following birth, but that rarely if ever happens.


EMTALA did not curb hospitals’ ability to force patients to pay. Quite the opposite, many hospitals have doubled down on trying to make patients do exactly that, regardless of the impact on the patient.


Hence, the one-sided financial consents. More recently, providers are trying to combine their self-serving financial consent with their standard consent to treatment. You must sign the latter if want treatment, assuming you are physically able to do so. If you come in unconscious or otherwise incapacitated, the presumption is that you want treatment, of course.


A Few Other Morsels


Let’s explore a few other things about EMTALA, the Quizzify Prevent Consent, payment disputes, and the No Surprises Act (NSA).


First is a bright-line distinction between the NSA’s patient protections and the Quizzify Prevent Consent. For the latter, it doesn’t matter whether the bill is in-network or out-of-network. The Quizzify Prevent Consent still works.


The NSA, by contrast, doesn’t apply to in-network overcharges for non-electives. Indeed, most of our video testimonials documenting massive savings from abusive billing are from in-network hospitals! (The NSA covers out-of-network elective care, though, while the Quizzify Prevent Consent doesn’t.)

And “benchmarks” for out-of-network billing disputes are the in-network rates. Emergency bills are often much higher than the 2x Medicare fee limit in the Quizzify Prevent Consent.


Besides bitter experience, the way you know those in-network rates are much, much higher than Medicare would pay is that, in the event of dispute, the NSA specifically forbids Medicare rates from being mentioned in arbitration hearings. That tilts the scale towards the provider.


Second, speaking of which, you might ask: “Doesn’t the NSA trump the Prevent Consent and require arbitration for billing disputes?” Answer: unless you sign the provider’s consent and waive your right to a trial, the 7th Amendment guarantees you can get one.


In other words, do not sign the provider’s consent if you want to avoid arbitration.


Third, the hospital is not required to accept the Prevent Consent. But to reject it – and, remember, they must treat you anyway – they must affirmatively write: “We do not agree to this Consent,” or something similar. If they don’t write anything, treating you constitutes acceptance.


Why Specifically 2x Medicare?


The Quizzify Prevent Consent specifies 2x (200% of) Medicare. A few morsels about that.


First. there is no magic to that percentage. If you are in a lower-cost region, you could pick 1.6x or something like that.


Second, the reason not to get greedy and specify an even lower multiple is that you want to be certain of winning in Court, if indeed a case ever goes to Court. Or, more to the point, you want the hospital to fear they might lose. If they lose in anything other than Small Claims Court, precedent is created. Precedent means their whole large-multiple-of-Medicare pricing system could come crashing down. If they do reject the employee’s offer, the higher the multiple of Medicare, the more reasonable the rejected offer sounds. The more reasonable the employee/plaintiff’s offer sounds, the more likely they are to lose. The more likely they are to lose, the more likely they will cave in fear that they could lose.


Third, even if the prices themselves are a reasonable multiple of Medicare, there are many things that providers charge commercially for that Medicare would not allow at all, as in this display where Medicare considers most of these line items charged to a commercial payor to be included in the ER charge itself.


Because this re-pricing was done in order to generate a dramatic (95.3%) reduction in an in-network bill, the prices, as low as they appear, are already 2x Medicare. (Credit to MedWatch for the repricing!)


Finally, ERs have been progressively upcoding for years, to the point where half of all visits are coded to Level 4 or Level 5. That is why the last five words of the Quizzify Prevent Consent specify coding at the correct Level, with “Level” in caps so the hospital knows exactly what we are talking about. This article recounts a classic example.










 
 
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