Tuesday, July 25, 2017

that's when the trouble began





And here's to you, Mrs. Robinson

 

Jesus loves you more than you will know, wo wo wo

 

God bless you please, Mrs. Robinson

 

Heaven holds a place for those who pray, hey hey hey

 

Hey hey hey...





____________________________





>> July 24, 2017 news article written by Julie Creswell, Reed Abelson, and Margot Sanger-Katz





-------------- [excerpts] --------- Early last year, executives at a small hospital an hour north of Spokane, Washington, started using a company called EmCare to staff and run their emergency room.  The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare was something hundreds of other hospitals across the country had done.





That's when the trouble began.





Before EmCare, about 6 percent of patient visits in the hospital's emergency room were billed for the most complex, expensive level of care.  After EmCare arrived, nearly 28 percent got the highest-level billing code.





On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. 


Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. 


For a patient needing care with the highest-level billing code, the hospital's previous physicians had been charging $467; EmCare's charged $1,649.





...Newport's experience with EmCare...is part of a pattern. ... ------------- [end, excerpts] ---------





~~  The article can be read online when you type in the title, "The Company Behind Many Surprise Emergency Room Bills"





-------------------------





Reader Comments:





Southwest ------ Just one more reason why we need single payer universal health care.





Jim    Santa Barbara, California ------------------- ...Predatory capitalism has no place in health care.  Sadly, it's also an example of why a single-payer system is so unlikely here:  Too many people accumulate wealth and political power in our current system.





David    Minneapolis ----- ...The ACA or any Republican ruse do little to address the real issue of rising healthcare costs.  Both sides are too beholden to big healthcare to do any true reform.








Ken Fabert  


Bainbridge Island, Washington


---- As a physician with 35 years under my belt and with over 5 years of ER experience before going into primary care, all I can say is that this is as appalling as it is predictable.  For-profit, unregulated "market based" health care will ALWAYS result in these sorts of systemic corporate abuses.  There is a simple solution:  SINGLE PAYER.








Sarah O'Leary


Dallas, Texas --------- I own a healthcare advocacy, and we are infuriated on a regular basis by mystery billing.  EmCare is deliberate and intentional in its efforts to defraud unsuspecting patients, as are many providers, insurers and manufacturers within the healthcare space.





How do they get away with it?  Just ask our Congress and administration....50% - 80% of all medical bills contain errors. 


Chances are, you'll get stuck paying what you don't owe. 


The government doesn't do anything to stop this fraud. 


Instead, Congress tries to pass a tax cut for the rich disguised as healthcare reform.  Disgusting.








Famdoc    New York ------- This is just the tip of the iceberg.  Keep investigating medical billing practices and you will find many abuses, not only in emergency care, but in hospital billing and in the billing practices of individual and groups of physicians.





Eugene Patrick Devany


Massapequa Park, New York


------ There is a better and fairer way.





In France there are no insurance company discounts and no out-of-network providers.  The providers charge the same fee for the same service to all patients.








Verona, New Jersey ------ "Fiona Scott Morton, a professor at the Yale School of Management and co-author of the paper, described the strategy as a 'kind of ambushing of patients.'"


--------


I would simply describe EmCare's practices as racketeering; obtaining or extorting money illegally or carrying on illegal business activities, usually by Organized Crime.





These practices and the entire American medical extortion industry need to be fully investigated and prosecuted under the Racketeer Influenced and Corrupt Organizations (RICO) law.





William    Memphis ---------- This is why Republicans want smaller government:  So that corporations can make obscene criminal profits and pay bribes to campaigns.








Tyrone    NYC ------- What is wrong with hospital administrators?  If you can't run your ER economically, what in the world would make you think that by adding a profit driven middleman, it's going to run at lower cost? 


It won't. 


It will run at a higher cost,


and since the middle man is profit driven, they will charge the patients as much as they think they can get away with.





The solution is to keep the ER operations in house, and offer salaries for staff sufficient to attract the staff you need, and adjust your non-profit-driven costs accordingly.  People may not be happy with the resulting modest bill increase, but it won't be the 3.5 times increase cited in this article.








Clyde    Pittsburgh --------- Emcare.  Enron.  It's all the same.  Many of today's businesses are predatory and are mostly allowed to get away with it.  When and if they do get caught, they pay a fine and move on.  The potential fines are built into their business plan from the start.


 
Alan Burnham    Newport, Maine ----------
...When I was injured at work, there were bills from doctors I never saw.  I reported it to my Union and company, and lots of bills got dropped.  Scamming by medical companies and doctors is epidemic.




Andrew --------- I live in a rural area in Arkansas and have had multiple parishioners in my church suffer this sticker shock.  Hospital is in-network, ambulance covered, tests covered, but the ER doctor is out-of-network.  Many of these persons do not have the resources to pay these heightened bills.


JAR    North Carolina ------- This is organized crime.  These physicians are part of a fraud and should be prosecuted under the RICO act.


KG    Pittsburgh, Pennsylvania
--- I am constantly reminded of what Bernie Sanders said:  "The business model of Wall Street is fraud."




Scott   
Middle of the Pacific ------- This article is a very good illustration of why we need to go to a single-payer system.  Under such a system there would no longer be "in network" and "out of network" nor would there be byzantine deals between insurers and providers.  Charges and coverage would be transparent to all; no surprises.




John Binkley
North Carolina ---------- There is no logical reason why a hospital or a physician should be entitled to bill one patient 4x or more what it bills another for the same service. 


This is another example of the scams that have grown up in the U.S.'s medical billing system, and go on because medical providers are simply charging the maximum they can get away with. 


The root problem is perverse incentives. 


In our third-party payment system, everybody involved has the incentive to raise prices to the hilt and hardly anyone has any incentive, or knowledge, or tools, to exercise cost and billing control. 


This is the fundamental reason U.S. medical costs have ballooned, and compare so unfavorably to other countries that have not made the same mistake. 


Strong regulation could help, but it will never happen with Congress in the palm of big-money medical industry donors. 


We all need to agitate to jump straight to some version of single payer, like every other developed country; it is the only cure for this disease.




Scott Crook
Winston-Salem, North Carolina
---------- In just about any business, when your vendor farms something out it is on them to pay the contractor.... 


For example, if you take your car to an auto repair shop, you expect to pay the shop, not receive bills from individual mechanics.




This is an element of the health care system that needs strong consumer legal protections.
 
If the hospital makes the decision to contract out labor, then the hospital should be on the hook for paying those contractors out of the money it bills to the patient or their insurance company.




The behavior described in the article is nothing more than a bait-and-switch tactic.


_________________________________


We'd like to know a little bit about you for our files


We'd like to help you learn to help yourself


Look around you, all you see are sympathetic eyes


Stroll around the grounds until you feel at home




And here's to you, Mrs. Robinson
Jesus loves you more than you will know, wo wo wo
God bless you please, Mrs. Robinson
Heaven holds a place for those who pray, hey hey hey


Hey hey hey




Hide it in a hiding place where no one ever goes
Put it in your pantry with your cupcakes
It's a little secret, just the Robinsons' affair
Most of all, you've got to hide it from the kids


Coo coo ca-choo, Mrs. Robinson
Jesus loves you more than you will know, wo wo wo
God bless you please, Mrs. Robinson
Heaven holds a place for those who pray, hey hey hey
Hey hey hey


Sitting on a sofa on a Sunday afternoon
Going to the candidates' debate
Laugh about it, shout about it
When you've got to choose
Every way you look at it you lose




Where have you gone, Joe DiMaggio?
A nation turns its lonely eyes to you, wooh wooh wooh
What's that you say, Mrs. Robinson
Joltin' Joe has left and gone away, hey hey hey
Hey hey hey


__________________
{"Mrs. Robinson" - Simon & Garfunkel,





on their fourth studio album, Bookends (1968).  Written by Paul Simon.  "Mrs. Robinson" has been covered by The Lemonheads,





Chet Atkins,





Bon Jovi,





and





Frank Sinatra.}


-30-

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