Petition to end surprise medical costs

Consumer Reports has a petition that asks for first hand accounts of how you have felt ambushed with big bills from specialists or other surprises when undergoing especially hospital experiences. Check out: 

endsurprisemedicalbills.org

This is in one sentence everything about the illogic of people: 

"You pick a doctor or hospital in your insurance plan to keep costs low. Yet loopholes mean you can get huge bills from specialists, labs and others not in your plan -- medical providers you didn't choose or have control over. Surprise! You're caught between them and your insurer, and they both want you to pay up."

People want to keep their premiums low but then they expect everything to be paid for. You can not have both folks. If you take a lower cost plan with a limited network you can not then expect to be covered outside of that limited network. And if you expect a company to have an unlimited network you need to expect much higher premiums.

And yet, if that's the insurance your job offers you, that's the one you take, and that's the one which f**ks you.

People feel ambushed because the medical billing process is completely Byzantine.  Suppose medical service providers had to provide a menu of services and the cost of each service? 

I am not saying that there are not issues. More information would be great. But this petition is illogical and goes at it all wrong.

bramzzoinks said:

This is in one sentence everything about the illogic of people: 

"You pick a doctor or hospital in your insurance plan to keep costs low. Yet loopholes mean you can get huge bills from specialists, labs and others not in your plan -- medical providers you didn't choose or have control over. Surprise! You're caught between them and your insurer, and they both want you to pay up."

People want to keep their premiums low but then they expect everything to be paid for. You can not have both folks. If you take a lower cost plan with a limited network you can not then expect to be covered outside of that limited network. And if you expect a company to have an unlimited network you need to expect much higher premiums.

Well, if I go to an in-network hospital, I expect the providers there to be in-network as well.  Seems silly that the building would be in-network but the doctors are all out-of-network.  If I go to the ER, am I supposed to wait for an in-network doctor to become available?

We once went to a specialist in network for a second opinion on a rare condition. The specialist is a well known practice, the Mayo Clinic. Some test were done to confirm the initial findings. We received an $1800 bill for the test because they were done at the practice and not by a LabCorp. 

Steve said:

bramzzoinks said:

This is in one sentence everything about the illogic of people: 

"You pick a doctor or hospital in your insurance plan to keep costs low. Yet loopholes mean you can get huge bills from specialists, labs and others not in your plan -- medical providers you didn't choose or have control over. Surprise! You're caught between them and your insurer, and they both want you to pay up."

People want to keep their premiums low but then they expect everything to be paid for. You can not have both folks. If you take a lower cost plan with a limited network you can not then expect to be covered outside of that limited network. And if you expect a company to have an unlimited network you need to expect much higher premiums.

Well, if I go to an in-network hospital, I expect the providers there to be in-network as well.  Seems silly that the building would be in-network but the doctors are all out-of-network.  If I go to the ER, am I supposed to wait for an in-network doctor to become available?

That is an issue with the hospital. Not the insurance company. And there are signs indicating this might be the case.

My insurance says that if I use an in network hospital,things that I have no control over like labs, anesthesia, assistants in surgery,etc, are paid at an in network rate and my responsibility ends there. Of course this is after deductible and co-insurance have been satisfied.

bramzzoinks said:

Steve said:

bramzzoinks said:

This is in one sentence everything about the illogic of people: 

"You pick a doctor or hospital in your insurance plan to keep costs low. Yet loopholes mean you can get huge bills from specialists, labs and others not in your plan -- medical providers you didn't choose or have control over. Surprise! You're caught between them and your insurer, and they both want you to pay up."

People want to keep their premiums low but then they expect everything to be paid for. You can not have both folks. If you take a lower cost plan with a limited network you can not then expect to be covered outside of that limited network. And if you expect a company to have an unlimited network you need to expect much higher premiums.

Well, if I go to an in-network hospital, I expect the providers there to be in-network as well.  Seems silly that the building would be in-network but the doctors are all out-of-network.  If I go to the ER, am I supposed to wait for an in-network doctor to become available?

That is an issue with the hospital. Not the insurance company. And there are signs indicating this might be the case.

Its an insurance company issue. Insurance companies have a lot of clout. They can require as part of the in-network contract that all in-hospital services be in-network.

But many insurers don't care. Why should they? This is cost shifting from insurer to patient.

bramzzoinks said:

Steve said:

bramzzoinks said:

This is in one sentence everything about the illogic of people: 

"You pick a doctor or hospital in your insurance plan to keep costs low. Yet loopholes mean you can get huge bills from specialists, labs and others not in your plan -- medical providers you didn't choose or have control over. Surprise! You're caught between them and your insurer, and they both want you to pay up."

People want to keep their premiums low but then they expect everything to be paid for. You can not have both folks. If you take a lower cost plan with a limited network you can not then expect to be covered outside of that limited network. And if you expect a company to have an unlimited network you need to expect much higher premiums.

Well, if I go to an in-network hospital, I expect the providers there to be in-network as well.  Seems silly that the building would be in-network but the doctors are all out-of-network.  If I go to the ER, am I supposed to wait for an in-network doctor to become available?

That is an issue with the hospital. Not the insurance company. And there are signs indicating this might be the case.

How is one supposed to shop around and conduct appropriate due diligence?  Hospitals and their providers should be bound to an insurance company for in hospital services once the hospital becomes in-network.  Anything less is absurd and a great bait and switch tactic.  Just another reason why regulation is necessary.

Those providers are not employees, affiliates or subsidiaries of the hospital. It is much like the designer label shops that are run as a concession at Macy's are not included in the "whole store" coupon days.

When my first child was born one of the people who looked at him in the hospital nursery wasn't in network.  I never even saw this person and didn't know they had examined him until I got the bill and received the EOB saying it was out of network. I was very lucky, when I called up my plan and explained that I purposely chose an in-network hospital to deliver in and that I had no control over who walked into the nursery and picked up my son, they agreed and covered the charge as in-network. Not everyone is so lucky and many are stuck with paying for expensive services even when they do their due diligence and follow the in-network providers lists.

We really need single payer in this country.

bramzzoinks said:

Those providers are not employees, affiliates or subsidiaries of the hospital. It is much like the designer label shops that are run as a concession at Macy's are not included in the "whole store" coupon days.

Yes, the fine print at Macy's excludes the concessions but it lists them by name. 

Unlike the hospitals which leave you guessing with a catch-all sign...

bramzzoinks said:

Those providers are not employees, affiliates or subsidiaries of the hospital. It is much like the designer label shops that are run as a concession at Macy's are not included in the "whole store" coupon days.

What JimMurphy said plus that you don't have to walk into the concessions and buy stuff there.  As Spontaneous points out, you don't have control over who attends to your needs in the hospital.

When you go to the petition link they do ask for your stories of experience.