By BOB HERTZ

We Need Legal Assaults On The Greediest Providers!

When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.

They are legally helpless, and vulnerable to price gouging.

Medicare offers decent protection — i.e. limits on balance billing, and no patient liability if a claim is denied.

But under age 65, it is a Wild West — especially for emergency care, and drugs and devices. The more they charge, the more they make. Even good health insurance does not offer complete financial insulation.

We need more legal protection of patients. In some cases we need price controls.

‘Charging what the market will bear’ is inadequate, even childish, when ‘the market’ consists of desperate patients. Where contracts are impossible and there is no chance for informed financial consent, government can and should step in.

This series describes the new laws that we need. Very little is required in tax dollars….but we do require a strong will to protect.

Assault Phase One: Outlaw surprise
billing

This rule must become universal:

If a hospital is
‘in-network’, then any doctor who practices in that hospital is ‘in-network.’

To enforce this, we should adopt Connecticut’s law on
surprise billing and balance billing for the entire nation.

Connecticut’s
law No.15-146, which took effect July 1, 2016. states
the following:

“If a patient receives a “surprise bill” from a health
insurer for Out-of-Network services provided at an In-Network facility – the
patient will only be responsible to pay the co-insurance, co-payment,
deductible, or other out of pocket expense that would apply – if the services
had been provided by an In-Network provider. 
The physician is reimbursed at the in-network rate,
unless the patient and provider agree upon something else in advance.”

In addition:

Patients who see Out-of-Network providers for
emergency services can only be required to pay the equivalent of In-Network
costs. This includes Out-of-Network hospitals, transportation services, and
providers who

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