Doctor booking app Zocdoc to start charging new patient fee despite objections from users

Some doctors say they could see a huge increase in their fees, but Zocdoc says it's appealing to physicians in more rural areas.
Health and Science

U.S.HEALTHCARE UPDATE:

Click today to request your free ACRX discount prescription card and save up to 80% off of your medicine!

SPECIAL DONATION REQUEST UPDATE:

Please help American Consultants Rx achieve it’s biggest goal yet of donating over 30 million discount prescription cards to over 50k organizations in an effort to assist millions of Americans in need. Please click here to donate today!

Refund On The Way To Latest ‘Bill Of The Month’ Patient

Sarah Witter had to pay for a second surgery to repair her broken leg after a metal plate installed during the first surgery broke. On Friday, she got a more welcome break — a $ 6,358.26 refund from the hospital and her insurer.

Witter’s experience was the subject of December’s KHN-NPR “Bill of the Month” feature. She and her insurer, Aetna, had racked up $ 99,159 in bills from a Rutland, Vt., hospital and various medical providers after she fractured her leg in a skiing accident last February.

A surgeon at Rutland Regional Medical Center implanted two metal plates, attached to her leg bones to help them heal. Less than four months later, one of these plates broke, requiring her to have a second surgery to replace the plate. Witter, who is 63, ended up paying $ 18,442, mostly to the hospital, for her portion of the total cost for all her care from the hospital, doctors, emergency services and physical therapists.

After KHN contacted Aetna about these costs, the insurer noticed that Rutland Regional had billed Witter for the difference between what it charged for its services and what Aetna considered an appropriate price for the first surgery. Those additional charges are known as “balance bills” and occur when a medical provider is not in the insurer’s network and has no contract with the insurer. Rutland Regional is not in Aetna’s network. In our original story, KHN had calculated $ 7,410 in balance bills.

Aetna said it contacted the hospital and negotiated a compromise in which the insurer paid the hospital nearly $ 3,800 and the hospital waived the remainder of the charges to Witter that Aetna considered unreasonably high.

“As part of her benefits plan, Sarah’s claims in question went through a patient advocacy process that allows us to negotiate with the provider on the member’s behalf to resolve any balance billing issues,” a spokesman wrote.

Aetna said it will negotiate disputed bills for any of its customers who request assistance, and also help schedule appointments, get services authorized and deal with other non-medical complications. However, an Aetna spokesman wrote, “we weren’t fully aware of all of the bills that Sarah had received before we received them from you/her.”

On Friday, Rutland Regional again declined to discuss Witter’s account. Witter said she learned of the refund during a meeting, at Rutland Regional’s invitation, with a hospital financial administrator.

“They went through all the costs and I guess treated it [the first surgery] more like it was a hospital service that was within my contract,” she said. The administrator told her they had “reprocessed” the charges from her second surgery, but that her portion of the bill did not change, she said.

“It’s good news — who doesn’t like getting money back? But I don’t quite understand,” she said. “If it’s that easy for them to reprocess this billing to get me this, then it’s obvious that everything is really arbitrary.”

One difference between the two surgeries was the first one was conducted during a crisis after Witter was admitted to the hospital through the emergency room. Balance bills in those circumstances are the most difficult to justify because patients with injuries that require immediate care, such as a heart attack or car accident, are usually taken to the closest medical facility. Patients are not in a position to figure out where the closest in-network alternative is.

Neither Witter’s hospital nor her insurer budged on her underlying complaint: that she shouldn’t have had to pay for second surgery, which cost $ 43,208, because one of the plates — known as a bone fixation device and manufactured by Johnson & Johnson’s DePuy Synthes — broke.

Device manufacturers generally do not offer warranties for hardware devices once they have been implanted, saying that device failure can be due to a variety of factors beyond the company’s control. Those include poor implantation by the surgeon; bones that fail to heal and subject the device to unremitting strain, causing metal fatigue; or patients who apply too much weight or movement on the bone despite instructions not to.

DePuy, which declined to comment for this story, earlier said that device failures occur in “rare circumstances.” In its instructions for surgeons, DePuy noted: “It is important to note that these implants may break at any time if they are subjected to sufficient stresses.”

Witter said her surgeon was present at her meeting at Rutland Regional and told her that “the fact the bone hadn’t completely healed yet was part of the problem.” She said she has not been able to find a contact for the device manufacturer so she can complain about it breaking.

Even after she receives her refund next week, Witter still will have paid $ 12,084 for her broken limb. Asked her advice for other patients dealing with bills they consider excessive, she said: “Don’t break your leg.”

Do you have an interesting or outrageous medical bill you’d like KHN and NPR to examine? Tell us about it!

Kaiser Health News

BEST DEAL UPDATE:

Massachusetts Stroke Patient Receives ‘Outrageous’ $474,725 Medical Flight Bill

Kristina Cunningham was in stable condition on an evening in June, when EMTs lifted her gurney into a medical flight, bound for Boston.

The 34-year-old couldn’t use her right arm or speak clearly after a stroke six days earlier, and still had two blood clots at the base of her brain. Cunningham’s dad, Jim Royer, remembers doctors at the small hospital in Wichita, Kan., where Cunningham had attended a family wedding, saying she needed to see a neurosurgeon.

“There was discussion of flying her to St. Louis, there was discussion of flying her to Chicago, there was discussion of flying her to Dallas,” Royer recalled, but “we don’t have family in any of those locations.”

So the doctors arranged to transfer Cunningham, via an Angel MedFlight Learjet, to Massachusetts General Hospital, where she would be diagnosed with a rare blood vessel disease of the brain. MGH is about an hour from Cunningham’s home in Berlin, Mass. — and her 7-year-old son. Cunningham’s doctors and her insurer, CareFirst BlueCross BlueShield, based in Maryland, agreed the transfer was medically necessary.

“We assumed it would be [covered],” Royer said, “because it was supposedly preapproved by the insurer before any flight took place.”

Royer said he and Cunningham didn’t think about the Angel MedFlight piece of her health scare again until a letter arrived in August. It was a one-page “explanation of benefits” with a jaw-dropping total in a column labeled “other amounts not covered.”
“When I got the bill for $ 474,725, I’m thinking six or seven flights, and you can buy a whole new jet,” Royer said with a wry laugh.

That nearly half-million dollars is the total of four items, the largest of which is a per-mile charge. That figure, $ 389,125, breaks down to $ 275 a mile.

“It’s larger than any surprise medical bill I’ve personally seen,” said Chuck Bell, program director for the advocacy division at Consumer Reports. “It’s really outrageous.”

In a study last year, Consumer Reports detailed some of the reasons excessively high air ambulance bills have become more common. Use of air ambulances is rising as more rural hospitals close, baby boomers age and the use of telemedicine increases.

“The industry has really grown by leaps and bounds over the last 15 years and prices have doubled or tripled,” Bell said. “Most of the operators of air ambulances now are for-profit, Wall Street-type corporations reporting very large profits to investors.”

The Association of Air Medical Services (AAMS), a trade group, counters that it is not unique, that many hospitals and health insurers across the country are also for-profit and that some are owned by private equity firms.

AAMS said a key reason bills for patients with private insurance plans are often high is this: Companies have to make up for the money they lose transporting other patients.

“Medicare pays about 60 percent of the cost of the flight. Medicaid pays 35 percent or less. Self-paid patients pay a few cents on the dollar. And that has led to a crisis of being able to sustain the service,” Christopher Eastlee, AAMS vice president for government relations, said in a statement, stressing that he has cost data only for emergency helicopter transports, not jets like the one in which Cunningham traveled.

In 2018, Medicare paid $ 8.65 per mile for a fixed-wing aircraft like the Learjet that transported Cunningham. That’s a stark contrast to Angel MedFlight’s $ 275 charge per mile. There are no guidelines for determining reasonable charges in this case.

Cunningham’s insurer, CareFirst, initially paid $ 14,304.55, leaving about $ 460,420 unpaid. In Massachusetts, a ground-based ambulance could not demand that Cunningham pay the balance, as state law doesn’t allow so-called balance billing. But air ambulances are governed by federal aviation laws. There are numerous cases of companies demanding payments from patients. A few states have tried to intervene but been unsuccessful, with courts saying that federal law prevails.

Cunningham has been focused on recovering her speech and preparing for surgery. In January, she will meet with her doctors to decide which type of surgery they recommend for removing or bypassing the blood clots at the base of her brain.

But Cunningham and her father have another worry: what the mail may bring.
“I don’t know, we’ll see,” Cunningham said, with a shrug.

“It’s a big bill to be sitting out there wondering what’s going on,” said Royer, who contacted KHN-NPR’s Bill of the Month on his daughter’s behalf. “It would force her into bankruptcy.”

Angel MedFlight COO Andrew Bess told WBUR the company is negotiating with CareFirst and will not demand payment from Cunningham.

“We’re quite confident we’ll come to a clear resolution despite the insurer placing the patient in the middle of the dispute,” said Bess.

Royer said it was a letter from Angel MedFlight that sounded threatening. As he read it, the company told Cunningham she must sign over the rights for Angel MedFlight to negotiate with CareFirst or risk being held liable if the insurer did not pay. Cunningham signed the request.

Bell, with Consumer Reports, said agreeing to such terms can be risky. Some air ambulance companies ask for detailed information about the patient’s personal finances, information they then use to determine how much the patient can pay if the insurance reimbursement is deemed inadequate.

During inquiries for this story, CareFirst told WBUR it would increase the proposed payment to Angel MedFlight. The insurer said it had discovered an error in its initial reimbursement to Angel MedFlight. CareFirst is now proposing to pay $ 70,864.90, or about one-seventh of the original charge.

“Unfortunately, exorbitant charges like these by air ambulance providers are not uncommon,” said Scott Graham, a spokesman for CareFirst, in an email. “This is an issue because companies like Angel MedFlight typically do not contract with health insurers on negotiated rates.”

WBUR forwarded this update to Bess, who called it a “meaningful offer” in his emailed response.

“We provide a valuable service, and for that providers should be fairly compensated and reimbursed,” Bess said. “We strive to work with our patients and advocate on behalf of them to get coverage rightfully owed to them under their insurance plans.”

Royer, a retired Air Force air traffic control systems manager, knows something about the cost of operating jets. To him, it looks like Angel MedFlight inflated the bill, hoping the insurer would agree to a generous settlement.

“I guess that the way things work nowadays. You ask for the moon and if you only get a large island, that’s what you get,” Royer said.

Bess responded to Royer’s claim in a statement.

“Staffing what is essentially an Intensive Care Unit at 30,000 feet presents unique medical and aviation challenges that may not be apparent to those outside of the medical aviation industry,” Bess wrote. “The amount we receive per flight is a fraction of the billed charge.”

Patients caught up in an air ambulance billing dispute can file a complaint with the U.S. Department of Transportation.

A recent push for stricter federal billing regulations was stripped out of the Federal Aviation Reauthorization Act, passed in October. The legislation did establish a council of industry representatives, including air ambulance providers and insurance company representatives, among others, to write and re-evaluate consumer protections, including balance-billing practices. It did not add a requirement for more price and other data transparency called for in a Government Accountability Office report on the air ambulance industry.

The National Association of Insurance Commissioners says federal legislation is needed so that states can intervene to oppose unreasonable air ambulance charges. Lawmakers from rural states, including Sen. Jon Tester, a Montana Democrat, said they’ll reintroduce such legislation.

The air ambulance trade group says any such change would create “borders in the sky” that would interfere with lifesaving air rescues across state borders.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

Do you have an interesting or outrageous medical bill you’d like KHN and NPR to examine? Tell us about it!

Kaiser Health News

BEST DEAL UPDATE:

12.17.18 Remote patient monitoring; Voice phishing; Cutting your internet cord

Remote patient monitoring is getting better and could save money on medical costs; Watch out for this voice phishing scam!; Could you cut your home internet cord? Turns out there’s a solution that you could be overlooking to help you do just that. 

Learn more about your ad choices. Visit megaphone.fm/adchoices

Watch the video
clark.com

BEST DEAL UPDATE:

Back To School Sale – Get up to 40% OFF stylish footwear at Payless.com

Kaiser Permanente Moanalua Medical Center Maintains “A” Grade for Patient Safety

HONOLULU — The Leapfrog Group, a nonprofit advocate for health care transparency, has awarded Kaiser Permanente Moanalua Medical Center its seventh straight “A” grade in the Fall 2018 Leapfrog Hospital Safety Grade. The Hospital Safety Grade, administered in the spring and fall every year, measures the overall performance of more than 2,500 hospitals nationwide in keeping patients safe from preventable medical errors. Moanalua Medical Center is 1 of 4 hospitals in Hawaii honored with the Straight A distinction of receiving five or more consecutive A grades.

The Hospital Safety Score uses hospital performance data collected by national health care organizations, including the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services. Scores are calculated based on 27 types of publicly available hospital data related to patient care, medication errors and infection prevention. It’s published as a free resource to help patients and their families make informed health care decisions. Only 32 percent of hospitals in the U.S. have received an A grade in the Fall 2018 report.

“Patient safety is a top priority at Kaiser Permanente, and we’re proud of our doctors, providers and staff who work together to create a healthy healing environment for patients,” said Linda Puu, RN, vice president of quality, safety and care experience at Kaiser Permanente in Hawaii. “Our integrated electronic health record system and coordinated care approach helps reduce errors and safety risks, which improves patient outcomes and ensures a higher quality of care.”


About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 11.8 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to kp.org/share.

The post Kaiser Permanente Moanalua Medical Center Maintains “A” Grade for Patient Safety appeared first on Kaiser Permanente.

Main RSS Feed – Kaiser Permanente

NEW PARENT ESSENTIAL UPDATE: