Stop The Hospital Shell Game!

There is one glaring blind spot among those debating how best to reform the health care system. It's my personal pet peeve–the fact that doctors don't have to accept the same insurance plans as the hospitals in which they work.

There is nothing more disconcerting than to walk into a hospital for surgery and see a sign warning: “Medical care providers may bill you separately for services rendered, and may not accept the same insurance as this hospital.”

This is no joke. Even if you make sure the hospital you are checking into is in your medical plan's network, and that your surgeon accepts the carrier's coverage as well, you still may end up getting billed by a radiologist, anesthesiologist or some other part of the vast medical team working on your case who does not take your insurance.

You can try asking the hospital to assign you only those who accept your plan, but that's not guaranteed. In fact, in one instance, we only learned after the fact that none of the anesthesiologists took any insurance at all–simply billing the patients and letting them fight to get reimbursed.

And you can bet you will receive a bill from any doctor who does not get paid by your carrier–following, of course, a polite statement from the insurer noting ominously that the provider is out of network, and must be reimbursed by you.

What's crazy, though, is at that point the medical provider can charge just about whatever they want and demand that you either pay in full or face a collection agency and the threat of a dark mark on your credit report.

Where is the justice here? Where is the common sense? Where is the humanity?

Critics of our current system say health care “consumers” should be “shopping” for care and picking what makes the most sense for them–from both an economic and medical standpoint. But how can one “shop” when a doctor just shows up to help with your surgery and gets to charge whatever they want?

This is not a “free market” at work–it's a classic shell game. Even if you play by the rules, you still get cheated.

This can prove to be not just extremely frustrating, but quite costly.

Every plan is different, but with mine, there is a $2,000 deductible for non-network services. (Keep in mind that's $2,000 according to what the insurer believes is reasonable and customary charges, not the fees actually charged by the non-network providers. That means you could run up thousands in out-of-pocket bills before hitting the insurer's adjusted $2,000 threshold.)

The only way to fix this is to stop making hospitals freelance centers, and start treating them like holistic institutions again. That means requiring doctors who work there to accept whatever health plans the hospital takes. If the doctors don't like that, they can work at the vet clinic across the street!

Am I being too tough on the poor medical community? After all, I see what my insurer pays to network providers, and it seems awfully low–just as the arbitrary fees charged by non-network providers sound outrageously high.

Perhaps to take the edge off this reform, the law could require hospitals to pay for malpractice insurance for the doctors who practice under their roof. Fair is fair, and I realize that doctors are paying a fortune for coverage today, thus driving up their costs. So perhaps this could relieve that burden.

The hospitals, of course, will scream bloody murder–unless Washington sets some reasonable limits on medical malpractice to help everyone out. But that is unlikely given the ties between the Democrats and the trial lawyers.

This is why the health care reform effort has proven to be so maddening. The system just doesn't work–at least from an insurance perspective–yet every attempt to fix it has the potential to cause more problems.

Still, if someone enters a hospital for care that is covered by their insurance company, that should protect the patient against any additional, unexpected bills. Otherwise, as I noted, it's all just one big shell game.

What do you folks think of my reform idea?