by Al Lewis
Our Six Things columns usually focus on issues that damage employee health due to employee ignorance. Surprise medical bills fit this topic perfectly. Nothing is more stressful for your employees – hence damaging to health -- than an unexpected bill that in some cases is larger than their paycheck.
Fortunately, we have an elegant solution. Don’t believe us? Gamble 4 minutes to read this through…
Maybe you are one of them? Two of us here at Quizzify have had that experience. In one case, it was a $38,000 bill for…stitches. (In all fairness to the ER that treated him, that included the bandage and the Neosporin too.)
His share amounted to $8000, which the insurance company mostly “waived,” meaning that his employer at the time paid the remainder, likely without looking twice at it. Certainly he never heard from anyone again.
2. This is most common for emergency room visits
For the most recent year available, 2016, 42.6% of all in-network in-hospital emergency department visits generated at least one surprise bill, with over 80% of ambulance trips generating one.
3. Surprise medical bills are not an accident – and get sent even to employees who know enough to stay “in-network”
One of the bigger scams in healthcare is to staff in-network facilities with out-of-network doctors. This often happens at off-hours – which of course is exactly when people tend to need to visit emergency rooms. Emergency room physicians have also figured out that while collusion is illegal between group practices, the same endpoint – charging high prices by refusing to sign in-network contracts – can be accomplished by joining together into a single group. The hospital and carrier thereby lose all leverage.
It isn’t just emergency care physicians. Radiologists, anesthesiologists, and pathologists often send surprise bills in general, and especially for work done in conjunction with emergency visits.
4. There is an entire industry – free-standing emergency rooms – whose business model is to surprise-bill patients.
You must educate your employees to steer clear of these beasts. The freestanding ER industry is so sketchy that these facilities aren’t even legal in about half the states. (In some of the states in which they are legal, they have to be hospital-affiliated…a status which often allows them to tack on a “facility fee.”) They are usually designed to mimic urgent care centers, like these:
The building does say “Emergency” on it but, after all, isn’t that what urgent care centers treat?
The same services always cost more in one of these facilities:
5. Employees can fight back…
Quizzify prides itself on how easy our fixes are. Like these for heartburn. We say that the difference between Quizzify and wellness is that in Quizzify 99% of behavior change is in knowing what to do, and only 1% is actually doing it. Whereas in wellness, it’s the other way around. Everyone knows they need to lose-weight-and-quit-smoking-etc., but 99% of the behavior change is actually doing it.
This is not that situation. Employees actually need to do something…but, as we’ll see in (6), you need to help them. Hospital emergency rooms (ERs), where surprise bills are most common, are required to treat anyone who comes in the door.
Before they do, ERs will typically make your employees sign a whole contract, electronically, which your employees will likely treat as though it were a “terms and conditions” document that doesn’t even have to be read…when in fact they are actually agreeing to be responsible for total charges. The outstanding new exposé on healthcare, The Price We Pay, covers this snooker in some detail.
The way out? Employees can insist on signing a printed copy of the consent, and insert the word “reasonable” where it says “I understand I will be responsible for charges not covered by insurance.” Or simply cross out that line altogether and sign the rest. They still have to treat you. That’s called, as described in The Price We Pay, “battlefield consent.”
6. …but not without your help!
Correct. It’s unlikely they can do this on their own. First, they have to have played Quizzify (or read the book) and remember that Q&A about surprise billing.
Next, in the heat of the moment they have to ask for the printout.
Finally, they have to push back when the ER person says: “You can’t do that,” or something to that effect. And they or a family member might be bleeding. Not a good time to get into a debate. Would be like trying to negotiate with the only taxi driver in sight during a rainstorm. That’s why taxi rates are fixed.
Fortunately, there is an elegant solution that you as an employer can implement. Simply give people a card (that they can take a picture of – and eventually we will make it something they can add to their Apple wallet) that they can sign that says: “I consent to appropriate treatment and (including applicable insurance payments) to be responsible for reasonable charges, up to 2 times the Medicare rate.” Quizzify has produced a template for our customers.
The back end can be varied, like “reasonable charges, with disputes to be settled by binding arbitration using the New York law as a model.” That law, based on Major League Baseball binding arbitration rules, is well-accepted and has generally been successful at curbing abuses.”
If you would like more information about Quizzify and our surprise billing quiz, just click here for more information.
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