Houston-Based Neurologist Explains Hospital Bills

A Houston-based neurologist, Dr. Steven Goldstein, explainsthe reasons patients can get very expensive hospital bills even if they went toa hospital, clinic or emergency room that is part of their insurance network onhis latest podcast. The Houston Healthcare Initiative podcast can be heard onSoundcloud, iTunes, Libsyn, or on the Houston Healthcare Initiative website.

While the insurance industry has trained patients, doctors,and hospitals that we all must have insurance and be part of an insurancenetwork, the same is not the case for doctors. While in-network doctors andhospitals have agreed with the insurance company how much procedures and testswill cost, not all doctors who work in hospitals are part of any insurancenetwork and can charge more than what insurance will cover. To make this worsefor patients, and the ultimate cause of ‘surprise hospital bills’ hospitals,emergency rooms or clinics are not required to disclose this to patients ortheir loved ones. As Dr. Goldstein told his listeners, “behind the scenes, thein-network doctor and the hospital agreed in advance what the charges weregoing to be. So, the in-network doctor is paid a flat rate based on thatagreement. The doctor who works at the hospital but is not part of theinsurance network can charge more and get paid more. He is under no obligationto say anything about this to the patient and will not.”

How Can This Be? Private Equity Companies

Private equity companies that own staffing firms and placedoctors to work in hospitals along with the American Hospital Association havestated publicly that restricting the independent pricing capability will makeputting doctors in geographic or socially challenging locations much more difficult,as higher pay is the biggest incentive for going to work in rural oreconomically disadvantaged areas. These doctors have no incentive to join aninsurer network, which would require them to cut their fees. These are thesource of many surprise medical bills.

Doctor Patient Unity Unmasked

A lobbying group known as Doctors and Patients United areowned and funded by TeamHealth and Envision Healthcare, private-equity-backedcompanies that own physician practices and staff emergency rooms around thecountry. In late July, 2019 Doctor Patient Unity placed more than $28 million inads opposing the legislation that would ban surprise medical bills, withoutdisclosing who was behind the ads.

Current Information on Federal Legislation

There are several committees and bills on this beingconsidered. At this writing the following bill was being considered: S 1895:Lower Health Care Costs Act. The bill was introduced by Senator Lamar Alexander(Tennessee) on June 19, 2019, and reported June 26, 2019. The committeesassigned to this bill sent it to the House or Senate as a whole forconsideration on June 26, 2019.

Dr. Goldstein is dedicated to reforming healthcare in theU.S. through education and information to the people who need it most.