Deja Vu All Over Again

I have commented before on the Humana/University of Louisville Physicians dispute (see Our Entitlement Mentality). Pat Howington’s story in this morning’s C-J yet again shines a light on disputes between providers and health insurers, this time Humana and ULP. (Read Pat’s story by clicking here.)

If you have never done so, it’s interesting to read the comments associated with the article on the website. Here’s an example or four:

Someone named Acebass (obviously a crack angler) commented as follows:

“Only in America could this happen, because all the other countries have universal health care where patient health trumps cost.”

It’s a shame we have to pay for everything.

Writer52 commented:

Out of network reimbursement typically involves paying off a massive deductible, being reimbursed at a lower rate, and paying a fee that is not discounted…often much higher than the “in-network” fee. Policy holders get shafted while the Humana execs and stockholders reap the benefits. BTW, it is in Humana’s interest to prolong this…after all, they are saving a bundle by not reimbursing the doctors during the period in which there is no contract!”

Now, to be clear, while I am 52, I am no writer, so don’t blame me for that one.

spndsmom wrote:

“The difference is a little more than just the 10% in in-network vs out of network. Last year, my daughter had to have surgery in the middle of the Norton/Anthem squabble. She had the surgery at Kosair. Now, there was a wonderful humanitarian article ran that stated Anthem would graciously pay Kosair bills at in-network rates, so as not to further burden families of ill children. Guess what? I got billed for well over $100,000.00 which was the difference between what they billed and what Anthem paid. There was no “agreed upon” billing rate or “usual and customary” writeoffs so we were balance billed the ENTIRE remainder of the bill. Don’t believe the “in-network” talk – it is meaningless. Norton asserted their “right” to balance bill patients for anything the insurance company did not pay because they had no contract with Anthem. Read the fine print people. This is a bigger financial disaster for patients than it appears on the surface.”

Ok, I have to take exception to this one. While I believe that spndsmom received a balance bill, I am certain that Norton would have made it right if it were brought to the attention of the business office, and perhaps, even if it weren’t. But that doesn’t matter as most people will believe what spndsmom posted.

Employers aren’t spared either, majjam posted the following:

“The Humana plan that my employer thoughtfully provides does not allow for out of network care, so it isn’t a matter of an extra 10% for some of us. So, the doctors that I have searched long and hard for that treat my lung cancer are out of my reach for right now.”

Thoughtfully? I detect a sarcastic tone here majjam.

The point is that everyone gets a black eye in a dispute like this one. There can be no denying that these types of disputes come at a real cost to patients and ultimately to employers paying for the care. And, there is no end in sight given the increasing financial pressures felt by all providers and especially by physicians.

So, hang on folks. The party’s just getting started.


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