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Out For Blood Is Right: Great Example of Outrageous Prices And The Need For Reform

Kaiser Health News, the healthcare news aggregator, also does tremendous original news stories. One of its series is “Bill of the Month,” where it features one person’s heartache related to a recent healthcare bill. In this article, KFF intervened to get the patient’s bill cancelled, but she is among the lucky ones. It is also important to remember that not all surprise bills you receive will suddenly go away under the No Surprises Act. This surprise bill was from an in-network provider (hospital), which was charging outrageous lab fees on everyday tests. The health plan negotiated a poor discount and the patient’s plan had the insured covering a percentage of allowable costs.

The article touches upon the need for site neutral payments to lower costs in the system and protect consumer’s from high costs. Why should hospitals be able to set ridiculously high fees for services that could be done around the corner at a free-standing lab for sometimes pennies on the dollar? Another outrage here — the provider’s behavior. The provider appears to be a hospital-owned (or at least aligned) provider referring to hospital-owned entities (in this case, a lab). This is without regard to the patient’s best interests. The provider knows they will get a surprise bill. Today, over half of all doctors are owned by hospital systems and help further drive up costs by practicing at or referring to costly hospital-owned places of services.

#pricetransparency #hospitals #healthcarereform #siteneutral

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