Two years ago I posted a blog called “Why I’m Mad at your Doctor” where I provided 2 specific illustrations of how I felt the medical system has been failing us as patients and fleecing us on our bills. One of the primary suspects in my examples was the anaesthesiologists who make our surgeries, well, tolerable.
If you don’t recall that post click here.
Here’s the short story: You go to an In-Network facility for your In-Network, covered procedure only to receive a SURPRISE bill a few months later from Guess Who? The anaesthesiologist. A person you possibly never met, 100% didn’t vet, provided by the In-Network facility. The one person who SURPRISE is NOT In-Network. That non-contracted provider hiding in your In-Network facility then charges you whatever exorbitant fee they decide and because they are not contracted, they will not negotiate with your Carrier. Not. Good. And guess what? Your health insurance Carrier knows all about this practice! In fact, they are so well versed in it that that have a strict policy in writing letting you know that they won’t deal with that doctor. Period. So Hi Ho, Hi Ho, it’s off to collections you go. Angry yet? You should be.
And here’s the good news: Politicians noticed. In September Governor Brown signed into law AB-72, Health Care Coverage: Out-of-Network Coverage. This law calls out this exact practice and states that if you visit an In-Network facility for a covered procedure, and a noncontracting individual health care professional provides services to you, they cannot charge you more than 125% of the amount Medicare reimburses (read: the rate the government would have paid) for the same or similar services. Hurray! Please tell me you are as excited about this as me. This is a BIG DEAL people.
Before you do that happy dance, you should know: This new law will apply to health policies issued, amended, or renewed on or after July 1, 2017. So it is not effective now, or retro-active. If you have any of those nasty bills right now- you’ll have to argue them yourself. Of course if you’re a client of ours, you have Alma (our Health Claims Advocate) to do that for you. She’s doing a happy dance just thinking about this law going into effect.
So be careful. Those non-contracted stowaways at your contracted, In-Network providers may still be lurking in this next year. But soon we’re going to have more tools to deal with them. FAIRLY. Then call me if you want to vent.