response to: surprise billing

response to: surprise billing
Geoff A. Modest, M.D.
Fri 12/20/2019 7:51 AM
  • Geoff A. Modest, M.D.

Mitchell Wice made the following comments (and agreed to their circulation). Mitch is a recent graduate from Boston Medical Center and is at the Icahn School of Medicine at Mount Sinai as an Integrated Fellow in Geriatrics and Palliative Care

-------



Another area of "surprise billing" is hospice. Because the way the hospice benefit is written into medicare with primary hospice doctor vs secondary seeing your PCP or specialist without prior special arrangements with the hospice can result in most of the bills and labs being denied when submitted to insurance and patients being left to pay out of pocket (at least medications can be picked up by part D). This is even more true as people try to refer to hospice earlier and earlier, which is a good thing. I blame this more on the hospice side with education to physicians who refer. I can't really blame family's because the emotions of enrolling your loved one in hospice is not really the time to explain to them and expect them to understand complex billing and that they possibly can't see their doctor of decades anymore, though unsure when you would cover this with family's.

Also another surprise billing from the ED is urgent care. A lot of urgent care's in cities I have trained are unknowingly to patient's still considered part of a ED and not an independent urgent care so the patients get billed at the higher rate. The amount of angry patients durings my residency and fellowship that would come to my clinic SW and complain how they tried save money but still got the larger bill is enormous.  

I also had own surprise billing. My insurance considers all doctors at my hospital primary in network so when you look them up on your insurance website or call the office you are informed they are covered in network. However, they have different "in network levels" so when I went to see a specialist I almost had a co-pay of $100 (instead of $0) plus what ever labs/test they would of ordered as would not be covered. Luckily the front desk informed me of this weird quirk before I saw the doctor and switched me to a physician fully covered, but I know most aren't getting so lucky.  

Comments

Post a Comment

if you would like to receive the near-daily emails regularly, please email me at gmodest@uphams.org

Popular posts from this blog

cystatin c: better predictor of bad outcomes than creatinine

  another article found significant discordance between creatinine and cystatin C in assessing renal function,  finding that the latter correlated most strongly with both renal and non-renal adverse clinical outcomes (see   ckd cystatin c better than creat AJKD2023  in  dropbox or doi: 10.1053/ j.ajkd.2023.04.002)   Details: -- 158,601 adults who were in the Stockholm Creatinine Measurements (SCREAM) project and had testing of creatinine and cystatin C on the same day during a healthcare encounter, from 2010-2018     -- >400,000 outpatient tests were done for both creatinine and cystatin C levels -- mean age 62, 48% female -- mean eGFR by creatinine (   eGFR cr ) 80; mean eGFR by cystatin C ( eGFR cys  ) 73 -- mean stage of renal insufficiency: 39%  eGFR cr   90+; 38%  eGFR cr  60-89; 12%  eGFR cr  45-59; 7.1%  eGFR cr  30-44; 3.2%  eGFR cr  15-29, 0.7%  eGFR cr ...
Read more

diabetes DPP-4 inhibitors and the risk of heart failure

the FDA just came out with a safety alert about 2 DPP-4 inhibitors and the increased risk of heart failure (released 04/05/2016)(see  http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm494252.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery ​ ). details: --saxagliptin and alogliptin were singled out because of 2 clinical trials in diabetic patients with heart disease. in each trial more patients taking these meds were hospitalized for heart failure vs those on placebo     --in the saxagliptin trial: 3.5% were hospitalized for heart failure (vs 2.8% on placebo). risk factors included prior heart failure or kidney disease     --in the alogliptin trial: 3.9% were hospitalized for heart failure (vs 3.3% on placebo) --recommendation by the FDA:     -- we should consider stopping these drugs if the patient develops heart failure ...
Read more

UPDATE: ASCVD risk factor critique

I decided to do an extensive update of my prior ASCVD (atherosclerotic cardiovascular disease) risk analysis and critique of risk calculators, with much more information about the “non-traditional” risk factors. I felt that there should be more data/clarification, since I think we are really undertreating/not preventing the most common cause of death by relying on the current ASCVD risk calculators   -- Cardiovascular risk models:      -- many of us rely on the various cardiovascular risk models to determine the appropriate approach to patients, and these are often integrated into the electronic medical records      -- these risk models have several very important limitations:          -- they are typically based on community data, eg from the Framingham study etc. But, in clinical practice, we are dealing with the individual and not the community:          ...
Read more