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

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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.  

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