Abusing the System

Lee S. Goldsmith, M.D., JD and Jordan Goldsmith, J.D.

As a patient you have a problem, and you want to receive care, or perhaps you have a loved one who needs care. You think that if you go to a provider, private doctor or hospital or urgent care center, that you will get care, pay your bill and be satisfied. These are your expectations.

Welcome to the real world of corporate or bottom-line medicine. 

On the news, there was a story of an individual who was insured privately through his employer and went to the emergency room near his home. He went to the emergency room because he needed immediate care. He was not thinking of his insurance. 

Ultimately, his condition required an admission to the hospital, where he stayed for four days. He did not ask when he arrived if his insurance was accepted by the hospital, nor did he ask the individual physicians who came to see and treat him if they accepted his insurance. He was ill and needed care. As it turned out, the hospital did accept his insurance, but the individual assigned to his care did not; nor was he informed of that fact at the time the physician arrived. Rather he was informed after he had been discharged and received a bill of many thousands of dollars. The physician’s group was not interested in his insurance; they wanted full payment of the bill.  

Some states have enacted laws to prevent this kind of surprise billing – also known as “balance billing.” If your particular state doesn’t have this type of protection, then attempt to negotiate with the hospital billing manager or the doctor who billed you to waive or lower their fee. It may also be helpful to speak with your insurance company.

If it is not an emergency and you have the time, ask your primary doctor to use in-network labs for bloodwork, MRIs and other tests. Beware of facility fees and see if a procedure can be done at a location that doesn’t charge one. Unfortunately, patients have to be proactive if they want to avoid being hit with large bills not covered by their insurance.