Editorial: Health care billing still too murky

Published Sept. 26, 2014

Determining the true cost of health care remains difficult, despite the government's recent release of valuable data about medical billing. Nationwide, doctors and hospitals engage in complex billing schemes that leave consumers largely in the dark until they get their bills. Health care reform continues to fall short in creating true transparency, and consumers continue to pay the price for legal loopholes that allow medical providers to charge exorbitant fees without reasonable justification.

The Tampa Bay Times' Jodie Tillman revealed Sunday that trips to the emergency room can result in sticker shock even for the insured. Patients who receive hospital treatment that is covered by their insurance carrier are often seen by emergency room doctors who subcontract with the hospital and don't accept patients' insurance. Those doctors routinely bill at rates that exceed the insurer's allowable fees. Yet the patient is still responsible for the difference.

Another shady billing practice highlighted recently by the New York Times involves drive-by doctoring or physician consults that often last mere minutes but can add up quickly in costs for patients. In some instances, the out-of-network physicians are performing tasks that could be handled by a hospital employee such as a nurse. A consult as minor as a physical therapist walking a hip replacement patient to the bathroom, for example, can trigger a big bill if the therapist is not a hospital employee. In one extreme case, a New York man who had neck surgery for herniated disks received a $117,000 bill from an assistant surgeon. The man had never met the surgeon, an out-of-network provider who assisted his orthopedist during the procedure. But the man's insurance company paid the entire bill to end months of wrangling over the unexpected cost.

One goal behind health care reform was to encourage more Americans to seek preventive care and steer away from costly emergency rooms. In theory, that should drive down the cost of health care for all. But around the country, doctors and hospitals have found sneaky, back-door ways to charge insured patients more money such as in the case of emergency room visits, when patients are most vulnerable. These deceptive practices should be stopped.

Florida law protects some patients from out-of-network doctors who pursue them for costs their insurers will not pay. But that is not enough. During routine planning for scheduled procedures, hospitals and doctors should be more transparent about exactly who will attend to patients and how much care will cost. When possible, consumers should be allowed to accept or reject add-on consults. And in emergencies, ER doctors who subcontract with hospitals should not be allowed to bill consumers for more than what their insurance would pay a doctor employed by the hospital. In the spring, a New York law that provides for transparency in out-of-network costs will take effect and shine a light on medical billing in that state. Other states, including Florida, should consider replicating that effort.