department of insurance, under pressure from the insurance industry and
patient advocacy groups, may fundamentally alter the way medicine is
practiced. In an effort to get a work around the
disgraceful- yet very culturally sensitive- single payer bill recently
vetoed by Governor Schwarzenegger, there is a move afoot to ban the
practice of balance billing.
the doctor does not have a contracted amount for the provision of that
service, she can bill the patient for that portion not covered by
insurance. Bill breaks his wrist and goes to an emergency room. Dr.
Jones comes in and ‘reduces’ (realigns) the fracture. Bill has his
insurance through Blue Cross. Dr. Jones has no contract with Blue Cross.
D(["mb"," This means that no matter what Dr. Jones bills, or believes his service is worth, or that a patient thinks a service is worth, it does not matter. The doctor must accept whatever the insurance company wants (or does not want) to pay.
means that no matter what Dr. Jones bills, or believes his service is
worth, or that a patient thinks a service is worth, it does not matter.
The doctor must accept whatever the insurance company wants (or does
not want) to pay.
control their payouts. It is clear that the one thing that insurers
actually fear is losing ‘insured lives’. This means people switching
from one insurance company to another. Disgruntled with their
insurance plan, employees, companies, and individuals switch companies
if they feel the insurer causes them too much grief. But, under this
new world of no balance billing, the only people who would complain
would be doctors. And, I can assure you, health insurance companies
are not nearly as concerned with physicians. Doctors cause their
‘losses’ (aka paying for work)
win for patient advocates who believe that health care is a
right—regardless what effect that ‘right’ might have on the
‘obligations’ of the physicians.
want someone to provide a cogent argument that, in a free society,
requires the doctor to work only for whatever the dictating outfit
chooses to pay— in 60 or 90 days.
answer—note that insurance contracts for patients forbid them from
paying for a service privately that the insurance company has denied. For
example, if the insurer refuses to ‘authorize’ a MRI, and the patient
decides to just pay out of pocket, he is in violation of his health
insurance contract. Hmmm.