Normally, we wouldn't bother posting about something that, after all, affects so few people, but I think there are some interesting lessons here.
Via email from Anthem:
"Wood Anesthesia and Pain Management, LLC, in Wood County, Ohio, has chosen to terminate its provider contract with Anthem effective 10/25/11 ... Consequently, Anthem members may be billed by Wood Anesthesia and Pain Management for any balance not covered by Anthem. However, since our members do not have a choice of anesthesiologists for surgeries performed at Wood County Hospital, Anthem will apply the equivalent of any member liability amounts" [emphasis added]
Anthem goes on to say that, although they'd really like to have hammered out an agreement that would keep the gas-passers in-network, the carrier has an obligation to its members (and, of course, its shareholders) to "negotiate a contract that will keep their health care costs as affordable as possible."
Remember: health care costs drive health insurance costs.
As we've previously discussed, "hidden providers" like anesthesiologists (and radiologists, etc) often have no incentive to belong to any network, and this case graphically illustrates why: "members do not have a choice of anesthesiologists for surgeries performed at Wood County Hospital." This is often (generally?) the case at most hospitals, and is one reason that folks are surprised (and not in a good way) when they are balance-billed for services rendered where no negotiations are possible.
It's fashionable to bash the carriers for heavy-handedness (and, frankly, they often deserve it), but here we have a very public airing of the specific problem.
I also got a bit of a smirk from this:
"[P]ayment for services will be issued to the member, who will then be responsible for making payment to Wood Anesthesia and Pain Management."
Nice.
This serves two purposes: first, the provider is going to have to go after the patient directly in order to be paid. One wonders how well that will work out. Second, and not-unrelated, is the fact that these patients will now see first-hand how much this part of their medical procedure really cost. One of the biggest problems with our current system (and, of course, the gummint-run ones, as well) is that the patient is insulated from the true cost of care. We know how much that oil change costs, because we foot that bill. And we know how much those peas cost, because we bought the can ourselves. But when health insurance (or the government) becomes an intermediary, the price is obscured and distorted.
What a great teaching moment.
Via email from Anthem:
"Wood Anesthesia and Pain Management, LLC, in Wood County, Ohio, has chosen to terminate its provider contract with Anthem effective 10/25/11 ... Consequently, Anthem members may be billed by Wood Anesthesia and Pain Management for any balance not covered by Anthem. However, since our members do not have a choice of anesthesiologists for surgeries performed at Wood County Hospital, Anthem will apply the equivalent of any member liability amounts" [emphasis added]
Anthem goes on to say that, although they'd really like to have hammered out an agreement that would keep the gas-passers in-network, the carrier has an obligation to its members (and, of course, its shareholders) to "negotiate a contract that will keep their health care costs as affordable as possible."
Remember: health care costs drive health insurance costs.
As we've previously discussed, "hidden providers" like anesthesiologists (and radiologists, etc) often have no incentive to belong to any network, and this case graphically illustrates why: "members do not have a choice of anesthesiologists for surgeries performed at Wood County Hospital." This is often (generally?) the case at most hospitals, and is one reason that folks are surprised (and not in a good way) when they are balance-billed for services rendered where no negotiations are possible.
It's fashionable to bash the carriers for heavy-handedness (and, frankly, they often deserve it), but here we have a very public airing of the specific problem.
I also got a bit of a smirk from this:
"[P]ayment for services will be issued to the member, who will then be responsible for making payment to Wood Anesthesia and Pain Management."
Nice.
This serves two purposes: first, the provider is going to have to go after the patient directly in order to be paid. One wonders how well that will work out. Second, and not-unrelated, is the fact that these patients will now see first-hand how much this part of their medical procedure really cost. One of the biggest problems with our current system (and, of course, the gummint-run ones, as well) is that the patient is insulated from the true cost of care. We know how much that oil change costs, because we foot that bill. And we know how much those peas cost, because we bought the can ourselves. But when health insurance (or the government) becomes an intermediary, the price is obscured and distorted.
What a great teaching moment.
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