FEATURE
sibility,” he says, “they are very aware of the issue of medical costs. You are also seeing entities like AARP push- ing seniors to look closely at their bills and act when the figures seem unusually high.” The action they take sometimes includes contacting the media, she says. “You are seeing a lot of news coverage of surprise medical bills. Readers are very sympathetic when they learn about patients who receive large, unexpected bills.” Consumers also are contacting their
government representatives, Schoeffel says. “Surprise medical bills are on the legal radar screen because of the growing number of complaints lodged by patients.”
Surprise Medical Bills
How to protect your patients from paying out-of-network prices BY ROBERT KURTZ
O
ver the last several years, patients have been bearing the brunt of the first dollars coming off the top for their care, says Stanford Plavin, MD, an anesthesiologist and owner of consult- ing firm Technical Anesthesia Strate- gies and Solutions in Atlanta, Georgia. “As insurance plans have transitioned from low co-pays and low deductibles with good out-of-network benefits to higher co-pays and higher deduct- ibles with little to no out-of-network benefits, patients are receiving what they perceive as inordinate bills. They might not have been previously privy to these bills, but they have essentially been around all along. That is where the ‘surprise’ comes in.”
Much of the initial national atten-
tion given to surprise medical bills focused on emergency services, says Scott Schoeffel, a senior attor- ney at Theodora Oringher in Costa
Mesa, California. “If patients must go to the emergency room, and par- ticularly when the facility is located outside of the area where they typi- cally receive medical services, there is a strong likelihood that they will receive treatment from an out-of-net- work provider. The bill the patient receives for their care can be many times higher than the bill would be if treatment were delivered by a con- tracted provider.” Non-emergent health care provid-
ers, such as radiology suites, freestand- ing physician practices and ASCs, are now paying more attention to surprise bills, Plavin says. Patients too are now looking more closely at surprise bills, says Grace Mack, a shareholder with Wilentz, Goldman & Spitzer in Woodbridge, New Jersey. “With their higher deductible plans and growing respon-
14 ASC FOCUS APRIL 2018 |
www.ascfocus.org
How They Reach ASC Patients ASCs are increasingly moving in net- work, says Michael Schaff, chair of the health care and corporate depart- ments at Wilentz, Goldman & Spitzer, in part due to pressure from insurance companies. “Payers have a motivation to move ASCs in network so they can avoid paying more expensive out-of- network bills.”
work, however, does not mean all its physicians follow suit.
Just because the ASC goes in net- “For exam-
ple,” Schaff says, “an anesthesiologist may take this approach if they can earn more providing the anesthesia services out of network than the center receives for the use of the facility.” In some instances, physicians are in network but the ASC is not, Mack says. “That was a big issue in the past, but it is less so today as most ASCs have become in-network providers.”
Most surprise bills related to ASC services come from health care pro- fessionals commonly referred to as invisible providers,” Schoeffel says. “These include anesthesia, pathol- ogy and lab professionals,” he says. “When patients think about receiv- ing surgical care, they understand that there is a surgeon and possi-
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