The doctor’s lobby makes hundreds of millions controlling the language of your medical bills. A new lawsuit is threatening to burn down the business model.
Hubs and I no longer get them because we wanted health care instead of sick care so we stopped going to physicians that take insurance. It’s expensive but worth it and I am truly grateful we can afford it.
We go to Dr. Sherri Tenpenny’s practice. You may have heard of her. 🥰
“No One Can Own the Law.” The AMA Apparently Missed That Memo”
THANK YOU for writing this article AND for making it possible to listen to it … I plan to encourage Dr. Margaret Aranda here on Substack to follow you. Her story is heart-wrenching and the fact that she is an anesthesiologist will make the essence of your article especially interesting to her.
"The rules required every hospital and health plan in the country to post actual negotiated rates, service by service, alongside cash price and sticker price, in free, public, machine-readable files that anyone can download right now, no account and no dime required."
The files are posted, but some are not accurate. Houston Methodist shows only what I think must be the highest negotiated rate they charge. I had a robotic assisted hernia outpatient procedure in January. Quoted $95K, half that for cash. I balked at that, knowing Medicare price was under $5K. I ended up paying $9500 cash (instead of using my high deductible plan, important shortly). Does not include surgeon fee ($6500 more), anesthesia, labs. Just hospital facility.
But the story has a cool plot twist. One of my direct report employees had literally the same procedure at Houston Methodist, different branch, four months later. He paid going through the high deductible plan a total of $3,200. For everything except labs and anesthesia. Included surgeon. That's the exact same plan I have, had I chosen to use it.
So the price posted is not remotely close to negotiated rates.
1. I didn't get the price from hospital until 4 days before surgery. Just ahead of CMS legal requirement of 3 days.
2. I did this as an experiment to learn how I would negotiate and what the rules are in practice should I decide to forego Medicare when I retire in 5 yrs. I think of the mistakes that cost extra money as tuition or educational investment.
3. Never got a quote for the surgeon until 5 weeks after surgery. Haven't paid the "discount price" of $6500. Going to file a CMS complaint about the lack of price 3 days prior. I have proof I asked repeatedly in the MyChart app. Should get the Medicare price plus a little of $1800 so they can avoid the $10K fine.
4. Once I negotiated with the hospital directly, I apparently voided my insurance company's right to pay for my in network treatment. Hospital has a duty to notify insurance prior to negotiating with me. Apparently they took advantage of my not knowing that. So no backup plan available to file insurance after surgery.
5. Nothing about the posted prices meets the intent of the price transparency law. They are gaming the system.
NEED A FORMAL AUDIT OROCESS WITH $5K / INCORRECT PRICE THAT MUST BE PASSES ANNUALLY.
Something like an ISO 9000 audit.
HOW DO I REPORT HOUSTON METHODIST FOR FRAUDULENT PRICING DATA?
Good. Burn it down. Thankfully, I don't have to care anymore since my patients pay me directly and I don't code.
Amen! Getting out of the matrix is truly the only way.
Re EOBs (Explanation of Benefits).
Hubs and I no longer get them because we wanted health care instead of sick care so we stopped going to physicians that take insurance. It’s expensive but worth it and I am truly grateful we can afford it.
We go to Dr. Sherri Tenpenny’s practice. You may have heard of her. 🥰
Thank you Katy for this most excellent post.
Amen, sister, on unplugging from the matrix!!
You got me on this …
“No One Can Own the Law.” The AMA Apparently Missed That Memo”
THANK YOU for writing this article AND for making it possible to listen to it … I plan to encourage Dr. Margaret Aranda here on Substack to follow you. Her story is heart-wrenching and the fact that she is an anesthesiologist will make the essence of your article especially interesting to her.
Thanks so much Sue, for spreading the word!!
Also, the AMA has turned JAMA from a respected academic publication into a platform for VC-bro marketing. As a peer reviewer, I find it appalling: https://sergeiai.substack.com/p/ai-will-replace-doctors-part-5-of
Ugh absolute fact and thanks for making that important point!!
Great piece. Thanks for the update
Thanks Kurt!!
You really should get someone to make a documentary about this for Netflix.
This would get the word out.
Wish I ran with the Hollywood types!!
"The rules required every hospital and health plan in the country to post actual negotiated rates, service by service, alongside cash price and sticker price, in free, public, machine-readable files that anyone can download right now, no account and no dime required."
The files are posted, but some are not accurate. Houston Methodist shows only what I think must be the highest negotiated rate they charge. I had a robotic assisted hernia outpatient procedure in January. Quoted $95K, half that for cash. I balked at that, knowing Medicare price was under $5K. I ended up paying $9500 cash (instead of using my high deductible plan, important shortly). Does not include surgeon fee ($6500 more), anesthesia, labs. Just hospital facility.
But the story has a cool plot twist. One of my direct report employees had literally the same procedure at Houston Methodist, different branch, four months later. He paid going through the high deductible plan a total of $3,200. For everything except labs and anesthesia. Included surgeon. That's the exact same plan I have, had I chosen to use it.
So the price posted is not remotely close to negotiated rates.
How does one fix that?
Very often true! CMS sent out 200 warning letters a few months ago.
Some clarifying points...
1. I didn't get the price from hospital until 4 days before surgery. Just ahead of CMS legal requirement of 3 days.
2. I did this as an experiment to learn how I would negotiate and what the rules are in practice should I decide to forego Medicare when I retire in 5 yrs. I think of the mistakes that cost extra money as tuition or educational investment.
3. Never got a quote for the surgeon until 5 weeks after surgery. Haven't paid the "discount price" of $6500. Going to file a CMS complaint about the lack of price 3 days prior. I have proof I asked repeatedly in the MyChart app. Should get the Medicare price plus a little of $1800 so they can avoid the $10K fine.
4. Once I negotiated with the hospital directly, I apparently voided my insurance company's right to pay for my in network treatment. Hospital has a duty to notify insurance prior to negotiating with me. Apparently they took advantage of my not knowing that. So no backup plan available to file insurance after surgery.
5. Nothing about the posted prices meets the intent of the price transparency law. They are gaming the system.
NEED A FORMAL AUDIT OROCESS WITH $5K / INCORRECT PRICE THAT MUST BE PASSES ANNUALLY.
Something like an ISO 9000 audit.
HOW DO I REPORT HOUSTON METHODIST FOR FRAUDULENT PRICING DATA?
Listened to this twice. Really interesting and important. I hope the suit is successful.
Katy: Way too many pictures. Photos of Tony and Michael don't add to your important article.
It doesn't need to be a magazine. Truth and facts are what is important.
For friendly Christian advice for a happy life, visit:
gentleinspiration.substack.com
I actually AM trying to do more a magazine. And I like pictures that make me laugh! Tomato/To-mah-to.
Personally, I thought it was pretty cool seeing all those handsome hoods in their prime!
Right??!