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Why are surprise bills like cockroaches?

Spray Raid on cockroaches and you think you’ve killed them dead. You do kill a few visible ones, but the others just scurry out of view.

Likewise, spraying the No Surprises Act on surprise bills will kill the highly visible headline-making bills -- like the infamous $11,000 COVID test – dead.

But most other surprise bills are just scurrying out of view. The large majority of surprise bills are indeed already “out of view,” because they come from in-network providers. This is largely because the vast majority of all bills are from in-network providers.

In-network providers, of course, are not covered by the No Surprises Act at all. That means you and your employees will still incur many smaller “surprise” bills. They aren’t really surprise bills in the sense that we are all so accustomed to paying large sums for medical care that 5-figure ER bills and 6-figure inpatient bills get auto-adjudicated and we don’t even notice.

Further, out-of-network surprise bills – which are allegedly covered by the No Surprises Act -- aren’t going away either. They will scurry out of view too. Providers may bill out-of-network care at perhaps a measly 4-8x Medicare instead of a zillion times Medicare. If your employees aren’t careful, they could end up in arbitration for one of these bills. In arbitration, the odds are stacked in favor of the provider. How do we know this? Because the No Surprises Act specifically prohibits the mention of Medicare pricing in arbitration.

How the Prevent Consent avoids all this

By way of background for the uninitiated, this simple but incredibly powerful language constitutes our “Prevent Consent, which an employee should write in, or have on an insurance card or preprinted card like this:

Superseding form consents, I consent to responsibility (including insurance) for up to 2 times Medicare following receipt of an itemized bill for appropriate treatment.

Unless an employee accidentally signs the provider's financial form too, which creates some uncertainty in its effectiveness (hence “Superseding form consents” above was added after exactly that once happened), the Quizzify Prevent Consent avoids all high bills for non-elective care—both out-of-network and in-network. And it avoids arbitration!

Wait… “It avoids arbitration”???

You might ask, how can a few words from a vendor (albeit a very smart vendor) trump an actual federal law requiring arbitration? That’s a great trivia question and the first person to answer it wins 20% off their first Quizzify contract! (If the first person to answer is a current customer, they get 20% off a 3-year renewal.) We will supply the answer in a subsequent email.

Nor is our Prevent Consent simply a theoretical solution, as it was when we first introduced it in 2019.

We’ve done a blog post and webinar on one such (in-network!) surprise bill and others are on our Testimonials page. Indeed, we have so many testimonials that our surprise bill “Prevent Consent” has its own category on that page, including an article about it in the New York Times, featuring attorneys weighing in.

Whether in or out-of-network, bills which otherwise could approach or exceed five figures rarely make it out of 3 figures, if patients use our language instead of signing the provider’s form consent. One such bill on the Testimonials page was: $478. This included a radiology consult which cost – get ready-- $32. Some hospitals charge that much for a Tylenol.

Lest anyone think the dramatic successes by Quizzify users are an anomaly, a recent article in the New York Times (via video by Dr. Eric Bricker due to article itself being behind paywall) shows otherwise. There is massive variation among hospitals and insurers in price. But one thing is for sure: Medicare reimbursement is almost always so much lower than commercial that our 2x Medicare offer will still be well below commercial. Here is an example, from that article:

By the way, the reason the Prevent Consent doubles the Medicare price is that we don’t want the hospital rejecting the Prevent Consent, treating our customers’ employees (as is required by federal law for non-elective care, even if there is no agreement on price) and then suing them.

While there is no magic to that 2x multiple, if someone proposes to pay only 1x Medicare, the hospital could conceivably reject the offer, treat the patient as the law requires – and then win a case, using the argument that an individual patient shouldn’t get the same price as Medicare, their largest customer.

By contrast, a hospital has so little chance of winning at 2x Medicare that they wouldn’t risk a trial. Remember, if they lose, it creates a precedent, except in small claims court. Even in small claims court, a loss could still get into local social media.

A precedent-setting loss in regular court places the hospital’s entire pricing structure in jeopardy, which is why our Prevent Consent has been used probably 500-1000 times with only one threat of a lawsuit, which never materialized for exactly that reason. We can’t say for a fact that our Consent has won every time, but if it had failed even once, we would have heard about it, because we stand behind it and guarantee success.

What should we do?

The No Surprises Act isn’t going to save you, so the action implication is quite simple: your employees should have this consent printed right on their insurance card, same as we do here (my example has the original language)

Our consent is free for the copying. It becomes more powerful (not to mentioned guaranteed) if you use the Quizzify quiz to teach employees how to use it, along with some of the nuances. For instance, it is important to teach employees:

  1. It works only for non-elective care. (They are welcome to try it anywhere, but an alert intake person would reject it and refuse to provide elective care unless paid according to the insurance contract or in cash.)

  2. Free-standing ERs and ambulances which ar not owned by hospitals are not required by law to accept it.

  3. We can’t guarantee that it will work if you also sign the provider's consent. So our quizzes teach employees not to sign what they put in front of you.

  4. It still counts against a deductible because it is a claim for medical care paid by insurance.

  5. You may want to reimburse at or close to 100% if someone uses this language.

Finally, take pictures of our Prevent Consent that you write in, record any conversation, and email yourself or have a companion do these things, just to make belt-and-suspenders certain that the record shows you did not agree to the provider’s consent, but rather they “agreed” to yours by treating you without objection.

Here is why you need to take a picture when writing it in -- otherwise they may lose the record of it:

Once you write this in and sign it, treating you without objection constitutes an acceptance of your offer. Don’t take our word for this – ask your attorney. Ironically, this is exactly the argument providers use when they sue patients: the patient did not object to the price they wanted to charge at the time of treatment.

Other vendors can help too. If you can convince or pay your navigation, reference-based pricing, or advocacy vendor to allocate the resource, you can just put their phone number on the card to call in case there is an argument upon intake. We can help train their personnel on how to respond. And, of course, in the case of Quizzify customers, we are right there to help as well, 16 hours a day.

With our help, you’ll be able to Kill. Surprise bills. Dead.


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