cmonfils | January 3, 2012
Employer’s Guide to Self-Insuring Health Benefits December 2011 | Vol. 19, No.3
By Adam V. Russo & Ron Peck
As avid readers of this article are aware, every month we write from the perspective of a self-funded plan, address how the health insurance industry should work, and what needs to be done to lower the cost of health care. Generally, we represent self-funded benefit plans and their third party claims administrators (“TPAs”). You may also know, specifically, that we have been spending a lot of our time dealing with conflicts that arise between these benefit plans and the health care service providers (“Providers”) that treat the plan participants. In this article, we want to look at these issues from the Providers’ perspective. You may be surprised by the differences in opinion regarding the value of preferred provider organizations (“PPOs”), and more shockingly, our common ground. (more…)
Category: Balance Billing, PPOs, Usual and Customary |
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cmonfils | April 19, 2011
John Commins, for HealthLeaders Media , April 15, 2011
California Insurance Commissioner Dave Jones has intervened in a whistleblower lawsuit against Sutter Hospitals for alleged false billing of what Jones said could be “hundreds of millions of dollars” for anesthesia services, his office has announced. (more…)
Category: Balance Billing, California |
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cmonfils | April 19, 2011
Sacramento Business Journal – by Kathy Robertson, Staff writer
Date: Wednesday, April 13, 2011, 12:50pm PDT -
Insurance Commissioner Dave Jones announced that his office has intervened in a multimillion-dollar whistleblower lawsuit against Sutter Health for alleged false billing of anesthesia services.
Insurance Commissioner Dave Jones went to the streets of San Francisco Wednesday to announce that his office has intervened in a multimillion-dollar whistleblower lawsuit against Sutter Health for alleged false billing of anesthesia services. (more…)
Category: Balance Billing, California |
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cmonfils | March 23, 2011
The Phia Group, LLC
March 22, 2011
Balance Billing… it happens. With health care reform in effect and costs of providing benefits soaring, our industry has become increasingly careful with their claims dollars. Plan Administrators, seeking to cut costs and enforce their plan documents, are combating provider overcharges with a new vigor. (more…)
Category: Balance Billing |
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cmonfils | March 15, 2011
www.businessweek.com by Chad Terhune
In a controversial practice known as “balance billing,” health-care providers are going after patients for money they don’t owe
Editor’s note: For a CBS Evening News report on balance billing that was made in collaboration with BusinessWeek, go to: www.cbsnews.com/stories/2008/08/29/eveningnews/main4398133.shtml.
As health-care costs continue to soar, millions of confused consumers are paying medical bills they don’t actually owe. Typically this occurs when an insurance plan covers less than what a doctor, hospital, or lab service wants to be paid. The health-care provider demands the balance from the patient. Uncertain and fearing the calls of a debt collector, the patient pays up. (more…)
Category: Balance Billing |
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cmonfils | January 12, 2011
www.fiercehealthcare.com
January 11, 2011 — 3:10pm ET | By Sandra Yin
A man sued Washington University in St. Louis, alleging the university’s doctors and other healthcare providers routinely overbill for medical services, the St. Louis-Dispatch reports.
The suit filed Friday asks for damages based on claims that thousands of insured patients have lost money as a result of the billing practices. (more…)
Category: Balance Billing |
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Adam V. Russo | May 26, 2010
California regulators have filed suit to stop growing hospital chain Prime Healthcare Services from billing commercially-insured patients for fees that insurance companies don’t pay. The practice, known as balance billing, is explicitly forbidden in some states, but California law is vague on this topic, according to observers. However, Prime’s practices are so extreme in this regard that they must be stopped, according to the state’s Department of Managed Health Care (DMHC). This follows an earlier initiative by California Gov. Arnold Schwarzenegger (R), who has asked the DMHC to work out rules that would forbid balance billing for all ED services. The DMHC issued draft regulations banning the practice earlier this year. (more…)
Category: Balance Billing, California |
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Adam V. Russo | May 19, 2010
Pretty amazing story – just got off the phone with a member who had to go to an Arizona facility (whose name I won’t mention in case I get sued!!!) and he said that when he sat in the waiting room for 2 hours, he noticed one woman who kept on bringing the patients in and the same woman kept bringing the patients out. When he finally met with this same woman, she specifically said to him that this facility is an out of network facility. They are an out of network facility with every single insurance carrier. Before they would see him (it was a trauma claim), he would have to sign a document agreeing to reimburse the facility the difference between what was charged by them and what would be paid by the plan. He was told that they would not be able to tell him the charges ahead of time!!! They then asked him how much he could afford a month. He said he could pay $100 a month and he had to sign the document right then and there. They did that with every single patient that walked through the door. When he went back there to take the cast off his hand, a woman came in for 10 minutes (a nurse’s assistant), took pliers, broke the cast off and then he left. He said he could have done that at home. That particular 20 minute session at this particular facility was billed at $8,500 to the plan. The plan agreed to reimburse $1,200 as usual and customary and the facility balanced billed the patient for $7,300. He is still getting letters and phone calls from creditors today. This is the problem with healthcare in our country.
Category: Balance Billing, Health Care Legislation, My Articles |
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