FacebookTwitterRedditEmail

The PR Campaign to Hide the Real Cause of those Sky-High Surprise Medical Bills

Most people assume that if they are treated at a hospital in their insurance network, the doctors they see will accept their insurance. But that’s not always the case. Since 2010, an increasing number of hospitals have outsourced their emergency rooms, radiology, anesthesiology, and other specialized services to physician staffing firms. Patients who need these critical services may inadvertently receive care from a doctor outside of their insurance network and find that they owe thousands or even tens of thousands of dollars in surprise medical bills.

Rates of surprise billing are highest for insured patients treated in emergency rooms. A Stanford University study of millions of ER visits found that more than 2-in-5 (43%) visits resulted in a surprise medical bill in 2016. A person who urgently needs care is in no position to argue and has no choice about either the ambulance, the hospital, or the ER they are taken to. One estimate is that almost 65 percent of U.S. hospitals have ERs staffed by outside firms. As might be expected, surprise billing is most likely to occur in these hospitals.

Horror stories abound. A woman in Hoboken left the emergency room of a hospital when she discovered that the plastic surgeon who would see her was not in her insurance network, and sought treatment at an in-network facility instead. Despite not having received a diagnosis at the first hospital and having left the ER without receiving any treatment, she got a bill from the hospital for $5,751. Her insurance plan paid the hospital $862, which it deemed a “reasonable and appropriate” fee for the services the woman received. That left her stuck with a bill for $4,989.

Patients stuck with surprise bills from out of network doctors are likely to be shocked at the fees they are being charged and angry at their insurance company. But they are unlikely to be aware of the Wall Street firms behind these bills.

Private equity firms have been busy gobbling up physicians’ practices and consolidating them into large national staffing firms. The two biggest physician staffing firms – Envision and TeamHealth – are owned by two of the biggest private equity firms – KKR and Blackstone Group. By 2013, these private equity-owned staffing firms had cornered 30 percent of the market for outsourced doctors, and private equity ownership of doctors’ groups has continued to grow. Private equity firms also own two of the three largest emergency ambulance and emergency air transport services – another major source of surprise medical billing.

Private equity loads these staffing firms up with debt and it promises its investors high returns. It keeps the doctors’ practices it owns out of insurance networks so it can collect high fees from patients. Or it uses the threat that its doctors will go out of network to bully insurance companies into paying its doctors much more for procedures than is paid to other doctors. Either way, health care costs and insurance premiums go up, and consumers pay the price.

Recently, bipartisan legislation passed through committees in both the House and the Senate that would prevent doctors and hospitals from sending big bills to patients for care provided by out-of-network doctors, most often by emergency room physicians. President Donald Trump called on Congress to protect patients from surprise medical bills. It looked like patients were going to be protected from surprise medical bills.

But legislation to roll back surprise medical bills will cut into the heady profits enjoyed by the Wall Street firms behind surprise billing. It didn’t take long for Envision and TeamHealth to reach into the deep pockets of their private equity owners to fund a dark money campaign and spend $28 million on ads intended to keep any legislation from passing. The ads don’t mention surprise billing. Instead, they claim that patients will be harmed if the government steps in to set rates – that is, limit how much out-of-network doctors can charge. Or they claim that big insurance doesn’t want to pay doctors and hospitals, without mentioning that these providers are out-of-network and can charge however much they want.

Medical debt is a leading cause of bankruptcy for families, and surprise medical bills are a major contributor to rising levels of medical debt. Patients need to be protected from unreasonable fees that don’t improve medical care but simply line the pockets of Wall Street investors. Congress needs to act.

This column originally appeared in the Star-Ledger.

More articles by:
Weekend Edition
July 03, 2020
Friday - Sunday
Peter Linebaugh
Police and the Wealth of Nations: Déjà Vu or Unfinished Business?
Rob Urie
Class, Race and Power
John Davis
A Requiem for George Floyd
Jeffrey St. Clair
Roaming Charges: Mutiny of the Bounties!
Richard D. Wolff
Revolutionary Possibilities: Could U.S. Capitalism Turn Nationalist?
Richard Falk
When Rogue States Sanction the International Criminal Court
Louis Proyect
Smearing Black Lives Matter…From the Left
Ralph Nader
Trump and Pence – Step Aside for Professional Pandemic Scientists and Managers
Ramzy Baroud
Tearing Down the Idols of Colonialism: Why Tunisia, Africa Must Demand French Apology
Philippe Marlière
Challenging the French Republic’s Color-Blindness
Richard C. Gross
Attack, Deny
Lee Camp
Connecting the Dates – US Media Used To Stop The ‘Threat’ of Peace
Steve Martinot
The Desire to Kill
David Yearsley
The War on Kitsch
Amy Eva Alberts Warren – Rev. William Alberts
Why are Certain Christians Democratic and Others Authoritarian?
Lawrence Davidson
Covid Madness
Brian Cloughley
Britain’s Disorder and Decline
Ellen Taylor
The US Military Has Its Knee on the Throat of the World
David Rosen
White Nationalists on the Attack
Jeff Cohen
Politicians of Color Should Not be Immune From Criticism
Joseph Natoli
Drawn Away from Reality in Plain View
Frank Joyce
Give Me Liberty,  Give You Death
Jonah Raskin
My Adventures in the Matriarchy
Paul Street
The Racist Counter-Revolution of 1776
Kollibri terre Sonnenblume
The Corruption of the Democratic Party: Talking to Ted Rall about his new book
Medea Benjamin - Nicolas J. S. Davies
Trump’s Record on Foreign Policy: Lost Wars, New Conflicts and Broken Promises
Paul Edwards
A Bridge Too Far
Jennifer Joan Thompson
How to Do Things With Theses: Chile’s National Police Force Sues the Feminist Artistic Collective, Las Tesis
Shawn Fremstad
Vacations for All!
Thomas Knapp
A Modest Proposal for Compromise on “Confederate” Military Bases
Vijay Prashad, Eduardo Viloria Daboín, Ana Maldonado, and Zoe PC
Venezuela’s Borderlands Have Been Assaulted by COVID-19
Thom Hartmann
COVID Masks: The Latest Faux Conservative Outrage
Jesse Jackson
Mandatory College Football Practices in Time of Pandemic are Nuts
Nicholas Vincenzo Barney
Consensus Politics on the Fringe: The Intellectual Dishonesty of the Intellectual Dark Web
Ted Rall
The Data is Clear: Progressives Should Boycott Biden
Joshua Tartakovsky
Sergei Khrushchev: An Eulogy from His Close Student
Theresa Church
In Reconsidering ‘Normalcy’ Genetically Engineered Trees Do Not Belong
Chelsea Carrick
Let’s Not Lose Momentum
Adam Rissien
Sorry Secretary Perdue, Our National Forests are Not Crops
Paul Gilk
A Few Theoretical Percentages
Thomas S. Harrington
“New Corona Cases”:  A Phrase That’s Tells us Very Little, if Anything,  About the Actual Levels of Danger We  Face
Claire Chadwick
I Got COVID-19 at Work. I Won’t be the Last
George Wuerthner
The Upper Green River Should be a National Park, Not a Feedlot
Julian Vigo
Profiteering in the Era of COVID-19
Ravi Mangla
Policing is Not a Public Good
FacebookTwitterRedditEmail