RBR “Tet Offensive” This Year?

First there was news earlier of this year of Tenet’s attempts at a second bite of the apple .Now word reaches us that another hospital system may be gearing up to do the same.

Below is part of an email received from a lawyer we work with who advises what may come to pass later this year:

“We have credible information that the (NAME OF HEALTH SYSTEM), is the process of auditing all claims over the past year that were repriced via RBP and will be balance billing millions of dollars worth of claims going back at least 12 months.”

“They are also preparing a legal action against members and TPA’s / Plans who do not immediately comply with their re-billing requests.  My guess is this will come first part of 4th quarter.  This is mostly in the primary and secondary care level, but also the hospital level.”

Let’s consider some basic facts here:

First, Joe Sixpack doesn’t have an extra thousand dollars laying around.

Second, Plan Sponsor isn’t liable.

Third, juries have proven to be sympathetic to the likes of Joe Sixpack.

Forth, discovery process will expose hospital’s deep dark secrets

Fifth, press coverage will not be good for hospitals

Six, Assignment of Benefits is a contract.

Seven, any judgement tend to be based on fair market value, not billed charges

Eight, as hospital attempts to collect full billed charges grows, rest assured there will be strong political pushback by various state legislatures against them with more balance billing protection legislation favoring consumers.

Hospitals throwing a wide net out there in the hopes a few timid and spineless plan sponsors will bend over and throw money at them just to make them go away will end up on the losing side of public opinion.

Meanwhile Joe Sixpack, a hard working American, continues to struggle to pay his mortgage, car payment, cloths for little Johnny, beer and bar-b-que. Life is good.

Joe understands the system. Illegal immigrants receive free health care, so  why shouldn’t he?