“Walter, is that you…………………!
Government’s “See A Doctor Now” Program Is Gaining Popularity……………
Don’t have time to make an appointment to see a doctor that’s made days and weeks ahead of time? Worried about balance billing in case your plan doesn’t pay enough? Worried your insurance won’t be accepted?
Relax, the United States government has your back!
Go to the EMERGENCY ROOM! There’s one in every town. Go often. Go as many times as your little heart desires whether you need to or not. Cold, sneezing, sore throat, lonely, it doesn’t matter. Go! (For turbocharged benefits clutch your chest when entering the ER and complain loudly about chest pains while emphasizing your outrageously sore and possibly cancerous throat coupled with a throbbing tumor sourced and life threatening headache).
Don’t worry about settling up with the hospital business office. That’s your employer’s problem now.
All of this is made possible by the No Surprises Act. Rejoice and be happy!
Meanwhile back at the ranch………………….
Employers are seeing an uptick in ER visits like never before. Plan members aren’t stupid. They know how to game the system. They don’t care about what things cost. That’s the insurance company’s problem.
Hospitals too know how to game the system.
We are seeing ER visits routinely billed anywhere from $25,000 – $45,000. No that is not a typo. Hospitals know the rules have changed in their favor. No longer do they have to fruitlessly squeeze as much as they can from Joe Sixpack because the No Surprises Act doesn’t allow that to happen. But the law does allow hospitals to squeeze with abandon as much as possible from deep pocketed insurance plans.
Hospitals know such high charges are not justifiable. They know they will be getting something less. But with the arbitration rules set by the government to resolve ER disputes hospitals know they have the upper hand. Baseball type arbitration works best when there is a wide pricing discrepancy between the two opposing sides. The losing side walks away thinking “Whew, we avoided a bullet this time! Instead of paying $40,000 we got away with murder by only paying $8,000! on a $1,000 bill!”
A school district self-funded health plan is being hit hard with 95% of all hospital encounters at the emergency room. School employees know how the system works.
One member takes it even further. Her credit sucks. She lives from paycheck to paycheck. She can’t afford the $20 office visit copay or the $50 urgent care copay. So what does she do? She calls an ambulance for free transportation to the emergency room, is treated promptly with scant waiting time, and is back on her feet in minutes. She has done this multiple times racking up thousands of dollars at the expense of her fellow workers.
Such is the effect of unintended consequences. Government meddling is the problem requiring reconstructive treatment. An effective antidote is a strong dose of Direct Primary Care plus 24/7 virtual urgent care woven into the fabric of every group health plan across the fruited plains.
And that’s the way it is. This is Walter Cronkite, CBS News, good night.
