MEDICAL
MEDICAL BILLING AND MEDICAL INSURANCE...A PERFECT COMBINATION
TO INDUCE NARCOLEPSY.
BUT LET'S SAY YOU FACED
SOMETHING A LITTLE
MORE THREATENING
THAN EXCESSIVE
SLEEPINESS...AND HAVE TO
GO TO THE HOSPITAL.
EVENTUALLY YOU WOULD
GET A BILL FOR THAT
VISIT..AND YOU'D THINK
YOU KNOW WHAT TO
EXPECT WHEN THAT BILL
CAME.
YOU'D THINK.
LAST WEEK WE TOLD YOU
ABOUT HOUSE BILL 506.
IT'S AIMED AT ENDING
SURPRISE MEDICAL
BILLING.
WE'LL EXPLAIN MORE OF
WHAT THAT MEANS IN A
MINUTE...BUT NO
SURPRISE BILLS SOUNDS
PRETTY GREAT, RIGHT?
A GROUP OF IDAHO
DOCTORS WOULD
DISAGREE WITH YOU.
THEY SAY THE BILL COULD
HAVE MAJOR
CONSEQUENCES TO THEIR
PROFESSION...AND
EVENTUALLY YOUR CARE.
JOE PARRIS EXPLAINS.
IN EMERGENCY
SITUATIONS -- YOU LIKELY
DON'T
DON'T HAVE A SAY WHERE YOU'RE TREATED... BECAUSE, WELL, IT'S AN
EMERGENCY.
SO YOU'RE TREATED AT
THE HOSPITAL OR BY A
DOCTOR AND SENT
HOME.
BUT MONTHS LATER --
WHEN THE BILL COMES,
YOU FIND OUT YOU WERE
TREATED BY A PROVIDER
NOT CONTRACTED WITH
YOUR INSURANCE PLAN...
AND YOU'RE LEFT WITH A
MASSIVE BILL.
HOUSE BILL 506 AIMS TO
END SURPRISE MEDICAL
BILLING, NAMELY IN
EMERGENCY SITUATIONS.
SO, EVERYONE WINS
RIGHT?
IT'S NOT THAT SIMPLE.
BRIAN WHITLOCK,
PRESIDENT OF THE IDAHO
HOSPITAL ASSOCIATION,
SAYS THE WAY THE BILL IS
WRITTEN NOW, DOCTORS
THAT ARE NOT
CONTRACTED WITH
INSURANCE COMPANIES,
THOSE OUT OF NETWORK
DOCTORS, WON'T BE PAID
FAIRLY.
FAIRLY. "WE WANT THEM TO BE ABLE TO BE REIMBURSED
FAIRLY FOR THOSE
SERVICES
SERVICES THAT WE ARE ASKING OF THEM IN OUR HOSPITALS. IF THEY DON'T
FEEL THEY ARE BEING
REIMBURSED FAIRLY, THEN
THEY ARE NOT GOING TO
BE IN THE HOSPITALS AND
THAT WILL LIMIT ACCESS
TO CARE."
SO, WHY WOULDN'T A
DOCTOR JUST CHOOSE TO
BE IN-NETWORK?
WHITLOCK SAYS IT
DOESN'T QUITE WORK
THAT WAY.
"THEY CAN COME TO YOU
AND SAY WE WOULD LIKE
YOU TO BE IN THE
NETWORK, AND IF YOU
WILL COME IN TO THE
NETWORK, AT A LOWER
RATE, WE WILL
GUARANTEE VOLUME."
"BUT THEY MAY COME TO
SOMEBODY ELSE AND SAY,
SORRY WE ALREADY HAVE
"JOE" IN OUR NETWORK,
WE DON'T NEED YOU IN
OUR NETWORK."
IN EMERGENCY
SITUATIONS, HOUSE BILL
506 REQUIRES OUT OF
NETWORK PHYSICIANS
NETWORK PHYSICIANS
STILL
STILL BE
STILL BE PAID FOR THEIR WORK, JUST AT THE IN- NETWORK RATE.
TREASURE VALLEY
TREASURE VALLEY
EMERGENCY
EMERGENCY MEDICINE PHYSICIAN JONATHAN MILLER, BROKE DOWN
THAT MATH FOR US...
"IF YOU HAD $20 TO
SPEND AS AN INSURANCE
COMPANY FOR A
HOSPITAL VISIT, YET YOU
COULD CHOOSE
WHATEVER YOU WANTED
TO PAY US, WOULD YOU
GIVE $20? OR, WOULD
YOU GIVE $5 AND KEEP
$15."
IF PHYSICIANS AREN'T
BEING PAID A FAIR RATE,
MILLER SAYS THE BILL
COULD MAKE IDAHO'S
ONGOING DOCTOR
SHORTAGE WORSE.
"I THINK PEOPLE WOULD
LEAVE IF THIS BILL PASSES.
THERE ARE ALREADY
RUMORS OF PEOPLE
LOOKING TO LEAVE IF THIS
BILL PASSES AS WRITTEN."
MILLER SAYS HE SEES THIS
AS SURPRISE LACK OF
COVERAGE FROM
INSURANCE.
"THE WAY THAT THIS IS
CURRENTLY WRITTEN, IT
DOES NOTHING TO
PROVIDE BETTER CARE FOR
OUR STATE, ONLY SERVES
TO DEEPEN THE POCKETS
OF THE INSURANCE
COMPANIES."
WHITLOCK SAYS HOUSE
BILL 506 WAS DRAFTED
WITHOUT THE NECESSARY
INPUT FROM
STAKEHOLDERS.
"GETTING EVERYBODY TO
THE TABLE AND HAVING A
CONVERSATION AND
COMING TO AN
AGREEMENT ON
LEGISLATION MOVING
FORWARD IS THE BEST
WAY TO DO THIS RATHER
THAN A ONE SIDED PIECE
OF LEGISLATION THAT
ONLY TAKES CARE OF ONE
PARTY IN THAT
CONTRACTUAL
NEGOTIATION."
CONTRACTUAL NEGOTIATION."
NEGOTIATION."
SO,
SO, WHAT'S THE OUT OF NETWORK SOLUTION?
NETWORK SOLUTION?