“Balance billing” and “drive-by doctors” are contributing to growing out-of-pocket medical costs.
▻http://www.slate.com/articles/business/the_bills/2016/08/_balance_billing_and_drive_by_doctors_are_contributing_to_growing_out_of.html
Surprise medical bills from out-of-network providers are an all-too-common phenomenon, and in many cases a legal one. As insurers shrink the number of providers they contract with to participate in their networks to save money and crack down on the nation’s growing medical expenditures, consumers are more and more likely to inadvertently encounter an out-of-network provider and get balance-billed in the process. Last year, a Consumers Union survey found that over a two-year period, 30 percent of those with private health insurance received a surprise medical bill. In 2008, BusinessWeek estimated consumers paid at least $1 billion in balance-billing charges annually, a number that has almost certainly grown substantially. Since that time, after all, out-of-pocket medical costs for households with employer-provided health insurance have increased by more than 50 percent.
Consumers get hit with balance bills because in many places they’re powerless to stop them. In only a minority of states is there significant regulation of balance billing by doctors and other medical providers, but loopholes remain. New York offers some of the most significant protection, with prohibitions on balance billing in emergencies and in situations like Perry’s; even there, self-funded employer health plans—which many large corporations use to cover their employees—are exempt. Pennsylvania, where Perry lives, currently offers limited protection from balance billing in emergency situations, though there is a proposal on the table that would further limit the practice in some situations. The Obama administration recently proposed an initiative that would mandate hospitals attempt to ensure patients receive services from providers that accept their insurance, but almost no one expects any movement on that issue in perpetually gridlocked Washington .
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