Do Freestanding Emergency Centers purposely saddle patients with surprise medical bills?
Freestanding emergency centers have experienced rapid growth in recent years. This only proves that they offer real value for money. Otherwise, patients would have shunned them by now and they would have died a natural death. Despite this growth and the real value, they offer patients, FECs have been the victim of numerous falsehoods. One of the myths that FECs such as Bellaire ER face is that they saddle patients with surprise medical bills. This article will examine this falsehood and seek to dispel it completely.
FECs could actually help to lower the cost of healthcare
A recent study by the University of Michigan, which was undertaken in 2010, found that the average cost of inpatient care was about $35,000 per patient. This is quite a lot for any one patient to bear, considering that they have other bills and that their insurer probably will not cover such a huge bill.
It was found that outpatient ER care could actually help to lower this cost. However, since traditional ERs have an interest in getting patients into inpatient care, this may not always work well. FECs are not bound to any hospital, and they thus do not have an interest in the patient being admitted. It is thus likely that patients will get to go home when there is no need for an overnight stay. This could help them to lower medical costs
Surveys show that it is not the case
Numerous scientific surveys conducted by TAFEC show that a huge majority of patients are well aware of the bills they are supposed to pay. Thus, they do not complain about being hit with unexpected bills. This is contrary to the myth that many patients usually end up with surprise bills.
It is the insurers who are at fault and not the FECs
Under Texas law, there is a loophole, which sometimes leads to predatory behavior by insurers. The law in Texas says that emergency care must be reimbursed to health care centers at a “usual and customary” rate. However, the law is silent about what “usual and customary” means. The insurers thus take great liberty when coming up with a definition for each case. Thus, while some insurers will give adequate reimbursement, others will not.
The FEC is left with the option to collect the debt from the patient or get in touch with the Texas Department of insurance. Some will go to the department, while others will go to the patient. In all honesty, it is the easiest decision as it helps to free them up to run the FEC. The patient can then take up the issue with the department if they feel their insurer acted in bad faith.
Some patients just do not understand the law
The Affordable Care Act makes it clear that all patients have a right to receive emergency care. Thus, a person cannot be penalized for going to an FEC for care. The ACA leaves the determination of what is emergency care up to the patient. Whenever the patient feels they have an emergency, they are at liberty to visit an FEC, whether it is in-network or not.
However, there are numerous health plans that are not compliant with these rules. When making a determination, they do not uphold the patient’s decision to visit the FEC based on their personal assessment. They make their own determination and pay less than they should. This is what leaves patients with surprise bills. However, if patients understood the rules, they would challenge this illegal activity by some insurers. The blame is thus unfairly laid on the FEC.
Billing mistakes occur
Sometimes simple billing mistakes occur. Remember that FECs are open 24/7, which means they are always handling new patients. There is no off peak time during which they can rest and get things in order. It is thus up to you to check the bill carefully to ensure that it contains no mistakes.
Many mistakes may occur including the wrong billing code, wrong procedures, or diagnosis being included, or even the wrong name. A few minutes checking the bill for problems could help to save you many problems associated with an incorrect bill.
The insurance company may be taking its sweet time to pay
Sometimes, some insurers will take their sweet time to pay the bill in the hope that you will pay it. It is morally wrong. It is thus important for you to pursue your insurer when you are hit with unpaid bills. Record every conversation with your doctor and the insurer and pursue them to the end. Eventually, they will fess up if they have no legal ground on which to stand. If your insurer is prone to such games, you may want to think about changing insurers. However, it goes to show that the FECs are not at fault. They cannot be held responsible for the mischievous actions of your insurer.