The Fix For Surprise Hospital Bills May Lie In Stitching Up Federal Law

 

The History of Health Insurance in the U.S.

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Legal and Legislative Guidance For Direct Primary Care Phil Eskew, DO, JD, MBA | DPC Summit 2019

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Video taken from the channel: Association of American Physicians and Surgeons


 

The Remedy For Surprise Medical Bills May Lie In Stitching Up Federal Law

Video taken from the channel: Cupple Webstar


 

A former physician reveals how to avoid surprise medical bills

Video taken from the channel: Business Insider


The simplest way to stop surprise bills would be through restrictions imposed by federal legislation that would apply to both state-regulated policies sold by insurers and employer-sponsored self-funded health plans, which are federally regulated. There’s a. Change federal law. The simplest way to stop surprise bills would be through restrictions imposed by federal legislation that would apply to both state-regulated policies sold by insurers and. The simplest way to stop surprise bills would be through restrictions imposed by federal legislation that would apply to both state-regulated policies sold by insurers and employer-sponsored. The Remedy For Surprise Medical Bills May Lie In Stitching Up Federal Law When people get surprise medical bills because they received care from out-of-network providers or clinicians, state laws designed to protect them from huge bills may not apply when their job-based health insurance if from a company that self-insures.

Gaps in a wide-ranging law covering employee benefits can blindside consumers whose health coverage is provided by company and union health plans that pay claims out of their own funds. Change federal law The simplest way to stop surprise bills would be through restrictions imposed by federal legislation that would apply to both state-regulated policies sold by insurers and employer-sponsored self-funded health plans, which are federally regulated. Change Federal Law. The simplest way to stop surprise bills would be through restrictions imposed by federal legislation that would apply to both state-regulated policies sold by.

Change Federal Law. The simplest way to stop surprise bills would be through restrictions imposed by federal legislation that would apply to both state-regulated policies sold by insurers and employer-sponsored self-funded health plans, which are federally regulated. There’s a precedent for this.

The Remedy For Surprise Medical Bills May Lie In Stitching Up Federal Law Change federal law. The simplest way to stop surprise bills would be through restrictions imposed by federal legislation that would apply to both state-regulated policies sold by insurers and employer-sponsored self-funded health plans, which are federally regulated. The Remedy For Surprise Medical Bills May Lie In Stitching Up Federal Law Gaps in a wide-ranging law covering employee benefits can blindside consumers whose health coverage is provided by company.

List of related literature:

Another recent approach to treating medical negligence as a crime is federal prosecution when a bill is sent to Medicare or to Medicaid for a procedure in which negligence occurred, alleging that fraud has been committed because the government paid for a service that was not received as promised.

“Principles of Risk Management and Patient Safety” by Barbara J. Youngberg
from Principles of Risk Management and Patient Safety
by Barbara J. Youngberg
Jones & Bartlett Learning, 2010

Rather than authorizing a federal agency to administer a uniform national health-care system for the poor, Congress offered States the opportunity to tailor Medicaid grants to their particular needs, so long as they remain within bounds set by federal law.

“Health Care Law and Ethics” by Mark A. Hall, David Orentlicher, Mary Anne Bobinski, Nicholas Bagley, I. Glenn Cohen
from Health Care Law and Ethics
by Mark A. Hall, David Orentlicher, et. al.
Wolters Kluwer, 2018

Several courts have used federal statutes to determine the issue of medical futility.

“Essentials of Nursing Law and Ethics” by Susan J. Westrick, Katherine McCormack Dempski
from Essentials of Nursing Law and Ethics
by Susan J. Westrick, Katherine McCormack Dempski
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First, the 1986 Omnibus Budget Reconciliation Act (OBRA) legally requires that a patient’s survivors be made aware of the option of organ and tissue donation.

“Clinical Nursing Skills and Techniques E-Book” by Anne Griffin Perry, Patricia Ann Potter, Wendy Ostendorf
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Some in Congress have introduced legislation, which is titled the “Ambulatory Surgical Center Quality and Access Act,” that aims to fix this problem.

“Office-Based Endovascular Centers” by Krishna M. Jain
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The nonpartisan Congressional Budget Officefi has predicted that this law would reduce the percentage of aggregate health care expenditures attributable to malpractice from 2 to 1.5 percent.22 5.

“Promoting Legal and Ethical Awareness: A Primer for Health Professionals and Patients” by Ronald W. Scott
from Promoting Legal and Ethical Awareness: A Primer for Health Professionals and Patients
by Ronald W. Scott
Elsevier Health Sciences, 2008

“This settlement is part of the United States’ on-going effort to combat the payment of illegal kickbacks to health care providers,” said Stuart F. Delery, Acting Assistant Attorney General for the Department of Justice’s Civil Division.

“The Law of Governance, Risk Management and Compliance” by Geoffrey P. Miller
from The Law of Governance, Risk Management and Compliance
by Geoffrey P. Miller
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Physician orders and agency policy should govern the nurse’s removing sutures or staples.

“Home Care Nursing Practice: Concepts and Application” by Robyn Rice
from Home Care Nursing Practice: Concepts and Application
by Robyn Rice
Mosby Elsevier, 2006

On July 1, 1986, the Consolidated Omnibus Budget Reconciliation Act mandated that the U.S. Department of Health and Human Services develop an RBRVS to be submitted to Congress.

“Spine Surgery 2-Vol Set E-Book: Techniques, Complication Avoidance, and Management (Expert Consult Online)” by Edward C. Benzel
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But the plan itself can normally be sued only in federal court and for just one thing: mistakes in deciding whether the plan should pay a particular medical bill.

“Making the Most of Your Money Now: The Classic Bestseller Completely Revised for the New Economy” by Jane Bryant Quinn
from Making the Most of Your Money Now: The Classic Bestseller Completely Revised for the New Economy
by Jane Bryant Quinn
Simon & Schuster, 2009

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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47 comments

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  • Which is why the concept of Obama-Care failed: NO COST CONTROLS!!!
    Why does Medicare have 3% overhead? Hint: Cost controls.
    Why is insurance so expensive? Hint: No cost controls (other than what insurance refuses to pay for)

  • If the US wants to stay with the capitalistic method of Healthcare shouldn’t they be doing so in a way that is transparent? Prices should be on everything so that people can shop around and doctors can save people money. Otherwise that’s not capitalism at all. Or people should be demanding for universal healthcare.

  • I Canada I just needed to wait (being patient is hard). We have this thing called a health card (looks different depending on which province/territory you live in but the same concept) which allows us to use medical services in the country (depending on where you live in Canada though). I just show it to my doctor. MRI/CT scanning/ultrasound? No transaction needed. Check up? No transaction required. Prescriptions/refills? Discounted/subsidized. Vision care? Both my prescription/checkups were discounted/subsidized (to a reasonable amount; still benefitted the patient rather than the doctors).

  • Very good advice. But it’s not just hospitals. I got a bill from some provider that basically said “You may not know who we are but we provided X service during your recent procedure, now give us money”. Ask your doctor’s office (the billers, not the doctor as they have no idea) about these type services and if there are alternatives.

  • One thing I always do when referred to an outside specialist, is refuse to sign all the forms at check-in, that say things like “I agree to re-imburse for extra charges”, or “I agree to pay”, or ” I understand the bills are my responsibility.”
    The specialist has a relationship with the primary care doctor, and the insurance company before hand. The specialist agrees to be paid at certain rates for certain procedures. In return, the pcm referrs patients to that specialist on a regular basis. If the specialist has problems with the rates they get paid, then they should maybe not agree to see those patients for set rates. But the forms presented to patient tell a different story. I make it quite clear that I do agree specialist should get paid on what they agreed to prior to seeing me, and it is their responsibility to get the referring facility and insurance to pay them. I also make it quite clear not to be sending me any bills. If they do not agree with me, they have the option to not see me. They always do see me, and do not wind up sending me bills. They get paid, by the insurance company, not me. I can see how other patients might wind up with bills.

  • Some country’s in South America you just go to your local pharmacist and tell them your symptoms and they describe what your options are and you buy whatever you want outright without insurance for pennies on the dollar.  The health care system here in the US is fucked up because of insurance.  I have good insurance from my work but if I had a major issue come up it would still probably be cheaper to go to a different country and pay cash for some things.

  • I feel that this lecture omitted or distorted some facts. (1) Single-payer means that a single governmental agency acts as the insurance company and insurance companies are not allowed to compete with the agency by offering policies that pay for services covered by the single-payer plan. It does not mean that there are no copayments or deductibles, necessarily, although elimination of copayments and deductibles may be a feature of most single-payer plans but not all. Example: Taiwan’s single-payer, there is a copayment for almost every service except some preventive services. (2) It’s false that prescription drugs are “not covered at all.” They’re not covered for home use, but prescription drugs administered while in hospital are covered and the Canadian system regulates home-use drug prices which is why drugs cost less across the border in Canada than they do in the US. (3) “De-listing services” is done by insurance companies also, such as by having a drug formulary which excludes many drugs and by excluding services the company deems to be “not medically necessary” or not proven to be safe and effective. (4) US insurance companies also limit payments to physicians through HMO and PPO contracts. Medical groups with such payment arrangements also push their doctors to see more patients per hour.

  • Or just live in a country that doesn’t rob its sick citizens to support the lofty lifestyles of the shareholders and workers of the medical industry.

  • It’s not his voice as an individual.
    It’s his business.
    He’s making his living by speaking.

    You may want to look at this real voice from the Canadian individuals.
    https://www.youtube.com/watch?v=VQFX32Ed7ZQ

  • Complete lies. Great but not perfect health care in Canada. Anything urgent you are seem immediately but if you have a sore toe or a cold yes you will wait 8 hrs. I am 60 and have cancer and I was seen, diagnosed and treated in 2 weeks. This guy is lying.

  • America used to be number one in education we have fallen to 36. They lowered the SAT scoring so that lower educated people can get into college. They allow immigrants in before Americans because it’s racist do not allow them to have a chance first they get it for free. We already are a socialist country they’re just not posting it up on the Billboard

  • The final line is Life expectancy in Canada is 12th in the world USA 31st between other rich countries like Costa Rica 30th and Cuba 32nd. Everything else is just BS. The insurance companies and big pharma rule the USA.

  • after this speech, ralph and the executive of the aaps went back to their headquarters, sacrificed a goat and burned a Canadian doctor at the stake

  • This would work in order to save money, but if I go to the hospital with a broken leg am I really on to say, send me to a cheaper lab for an X-ray just to save a buck, and possibly develop blood clots? It would really depend on the situation before I do something like this.

  • My neighbor waited seven years for surgery for trigeminal neuralgia in Canada. My son waited for a cancer diagnosis for five months. He flew to Boston and went into treatment at a major cancer center the day after he landed. I have experienced both health care systems, and America wins, hands down! This doc is speaking the absolute truth. My Canadian doc told me she doesn’t get paid enough to do physicals, unless you have specific symptoms. She said everything she needed to know she could find in my blood work! I know now that people with cancer often have perfectly normal blood work.

  • Oh yes you are bashing and your a privileged jerk because you do not understand our system…of course your a republican and your purpose is to ensure that no mecicare for all… reounce your Canadian citizenships you don’t deserve it. Your a disgrace. Your such an idiot…

  • Laughable nonsense. No Canadian politician would last a week if they proposed adopting American healthcare. The Canadian system is not perfect but it covers everyone costs half of the American system and delivers consistently better health outcomes. Fact.

  • You get sick here in the US and don’t have any money then you do without, because the cost is so high it will bankrupt you. Piss on the American healthcare system.

  • Interesting he asks if we can tell which young man was his in the basketball photo…why would we presume either one. The Canadians I speak to love their care. Of course in usa you are fine if you have a good insurance policy, but most who have coverage don’t get much coverage at all. And then many can not afford any insurance, any more, except perhaps catastrophic with a $70,000 deductible. Bankruptcies seem to be the big options, here. This guy must get excellent coverage from the way he speaks. The heck with those who don’t…let them die.

  • Health care in Canada costs us twice what it`s worth….what is thrown out is amazing…third world countries would benefit greatly from our garbage…why is this happening???

  • my wife had 4 heart attack 3 stents put in the pancreas operation hernia and stone operation 2 hip replacment no problem i still own my own home

  • Waited 11 years for major spine surgery and also have my spine fused. Fuc* off Canada.

    I am a Canadian and have to say it is a shit hole here and sadly the
    majority of the people are a bunch of brain dead idiots. Wait times for
    last ranked health care yes Canada is 8 hours. Alberta got hit with a
    french style terror attack back in Jan 2016 and the government blocked
    it from being spread through the news. Between 5000 to 7000 people are
    murdered each year by the Federal and Provincial governments by using
    wait times in the health care to kill off portions of the population
    that saves both governments money big time. The feds don’t have to pay
    out pensions to those who are dead. The governments uses the bullshit
    Privacy laws and the Communist Tribunal system to keep its human rights
    and mass discrimination of its people from the WHO, Human Rights Watch,
    the media and the people from having a clue what the government has been
    doing. The feds only provide 1/3rd funding for education to the
    natives that is pathetic but is willing to hand over 26,000 to 28,000 a
    year to tens of thousands of foreign smucks who make the political party
    look good around the globe. Never mind that they are guilty of
    atrocities against their own people. The Canadian system is a commie
    Hypocrisy that is the mast of the world in deception. manipulation and
    deceit against its populous. And sadly the people are so Ffffing brain
    washed not to look past their nose and outside the paper towel tube they
    have been trained to tool through since the commie dictatorship they
    has in the 1970’s yes the father of the jerkoff now in the PM seat.

  • I get great healthcare in CANADA this guy is so full of B.S.it‘s all propaganda by people who need to scare the U.S. population from the right to healthcare for all. Do not believe this crap.

  • Lmfao…They are trying to Keep American’s Stupid…Don’t Want Free Healthcare…Ask To Pay For It…It’s Better and No Wait Times if You Allow Us To OVercharge You $30 dollars for 2 Tablets of Tylenol….GTFOH!!! I wouldn’t care how long the wait was if it was Free… Ask American Wealthy/Rich and Political Parties do they Pay for their Health Insurance…No..Because Why SHould they if American Public is Stupid enough to Pay for their own and the Political Parties..Blame Nixon..He started this Scam shit.. Now Americans Should Have Free Healthcare They Deserve It…Especially if the Wealthy Do.. If You Believe this Bullshit..You’re Fucking Stupid!!! Go Drown Yourself…If your leaders aren’t adding into the pool of funds..why should you…#FreeAmericanHealthcare… ObamaCare was the Right thing to do…Idiots…Soldiers were/are getting Free Limbs for their efforts now.. Where was the help before? The VA? Give me a Fuckin Break…

  • Alberta has 2 levels of Health Care. Peasant Care ( 3 month wait to see a specialist, 6 to 9 month wait for surgery) and Private Care for folks with enough money (like politicians) to go to the US and get treated immediately. BTW taxes don’t cover the cost Provinces are borrowing to make up the short fall. Money is diverted from other programs like National Defense and law enforcement to pay for health care. But we don’t care that our children and grand children will be paying the bill we don’t care

  • I have read the most vicious, anti-American, anti-US healthcare diatribes from Canadians here and it has pissed me off to no end. I’ve gone back at them time again saying exactly what this man is saying. My Canadian born daughter-in-law’s stepdad needed a heart bypass and was told he have to wait at least 18 months for the surgery. He and his wife came here to the US, to Prescott, Arizona actually, and got it all done in 2 weeks. Oh yeah, everyone HATES The United States of America but GOD ALMIGHTY doesn’t everyone want to come here.

  • Listening to this guy, and relating it to my experience, he is full of something that obviously the American medical system has been unable to remove….he is providing propaganda for his masters….meaning that most of the information he gives out is, at the most, half truths and at some places has no relationship to reality as it exists here in Canada.

  • I am Canadian,  I would never want to lose my healthcare system….  I have never waited an unreasonable amount of time for treatment of any kind….  Normally I go once a year for a physical this sometimes include x-rays if needed, blood work etc. all for free.

  • Trump needs for people like this man and so many others live in a country that has universal free insurance. Have them tell their story of how they cannot get treatment. Only the rich can afford private insurance and the poor pays 50% taxes and then when you pay your taxes you have to pay taxes on your Texas. You pay all the taxes and you can’t even get any service. This is what Americans need to know.Bernie Sanders has everyone so brainwashed thinking they can walk in and get their free pills

  • I’m a Canadian and this doctor is spot on! I can tell you first hand that here in BC we do have many residents that do not have health insurance and many procedures are not covered, wait times are insane and overall the care is garbage. His words are the truth his message very clear! One example in my case I went to my doctor as I twisted my knee and could hardly walk, I was told the soonest I could get in to see a specialist was 1 year! I could go on and on…trust me, this guy is not a shill spreading propaganda as many of you are making him out to be he appears to be an educated, awakened man who has unveiled the hidden truth about Canada’s health care SYSTEM for what it is…crap! The best healthcare I’ve received so far has been Czech Republic, Romania (yes, Romania where foreigners also get FREE healthcare in a public hospital, or you can pay for private so you have a choice!) and Thailand.

  • This speech was supposed to be about the Canadian medical system, but is peppered with ideology and politics. Not only that, there are so many half-truths, the substance of it is fabrication in totality.

  • The Canadian system does have problems, and we need to talk about it but not with this guy! If he were an expert, he’d be specifying the province in which his factoids refer to, since healthcare is administered by the provinces, not “Canada”. This is just a lot of false sensational facts and distortions, meant to make his fellow right wing AAPS members feel comfortable with their position. We need balanced discussions that include the voices of patients, doctors, government, hospitals, insurers, experts who study healthcare systems etc., and in an international forum.

  • A voice for private physicians so they can charge a lot. The health care system is based on Satanism which means benefit from those who are in crisis. NO care  in the profession for other but for yourself. Do as thy wilt is the hole of the law.

  • Weird it’s either he is the devil or a saint no middle ground on the comments.they discount each other’s testimonies.sounds like our politicians lol

  • This man’s son who got hit by a car had exactly the same experience I had when I was hit by a car. The only difference was that I was covered by a California HMO. I had been knocked unconscious and my face was badly cut open in addition to spinal and hip injuries. No CAT scans done, just stitches and sent home. They claimed that it was a third party liability claim, so they didn’t have to pay for my care and then would take the bloateD price charged by the ER out of my settlement money. I tried to get care from my assigned clinic, but they just sent me home with advice to take some Tylenol. I had to get an attorney in order to get some care. By the time I actually got any treatment three months had passed. Fast forward, and I now have permanent painful injuries due to delayed care. The break in my back healed wrong and I have permanent nerve damage in both legs and one arm. HMO’ S are given the ability to kill and cripple people ( ERISA federal law) because they cannot be sued. I have spent more than ten times my settlement (15k, because he was underinsured) out of my own pocket and many problems could have been avoided if they had at least done a CAT scan, but my insurance HMO denied that request.

  • Reminds me of a recent story in Australia where we have government healthcare. To avoid the penalties attached to not seeing and admitting an emergency patient in under the mandated 3 hours, one hospital got around this by ‘admitting’ patients to an empty ward using a retired doctor’s name who had no knowledge his name was being used.

  • I have heard US Citizens talk about being unable to return home because no one will insure them, they are “stick” in Canada where their costs are covered. Oh and hist basketball story is so full of sh*t.

  • The AAPS is a ridiculous group with ridiculous beliefs:

    https://en.wikipedia.org/wiki/Association_of_American_Physicians_and_Surgeons#Advocacy_of_non-mainstream_or_scientifically_discredited_claims

  • It’s so funny to see the sheer amount of triggered Canadians commenting here. They don’t like hearing that their system, just like the NHS or any other system of single-payer medicine, inherently provides poor care to patients due to misallocation of resources.

    I’ve worked as a Clinical Researcher in the second best hospital in the state of Ohio and have multiple connections to the Cleveland Clinic, which by some metrics is considered the best hospital in the world. I know what high quality of care is extended even to those without the ability to pay in the US.

    In short, yes, you pay a ton of money for healthcare here. You are also given the top quality of care available in the world. Better to be in debt and alive than dead on the government’s dime.

  • I’m always amazed at the horror stories, that emerge in the US concerning Canada. I’m Canadian and I have never heard of such dreadful events among my acquaintances. I got surgery in six days, last time. I found a new doctor in the same building at once, after I dumped my then doctor.
    Where on earth does this man get the comment about only a mastectomy available to seniors? And the sob story about his kid playing basketball?
    He did mention he is Republican…

  • So you have a system where the Doctor can fire the patient, but that puts no pressure or onus on the patient to keep his mouth shut if there ARE problems? And we’re supposed to accept the word of someone who lives under that system that everything is fine? That things are even OK?

    That’s like asking the prisoners at a concentration camp what they think of the food when the guards are watching….

  • My husband worked here in the US for a Canadian company and frequently had to travel to various different provinces where they had operations. ALL the comments below by Canadians are true he says. Different areas have different responses with their health care. Having lived in the US all our lives, he did find the “system” very unreliable and sporadic. He worked in safety and health and therefore became quite informed about Canada’s health care system. Availability and wait times were frequently AWFUL! After 17 years with this company he came to the conclusion that he would Fight socialist health care in the US at ALL COSTS!!!

  • It sounds like people that come out for private insurance are just bought and paid for. They’re protecting the interests of their benefactors. It seems to me Canadians and other citizens of countries with Universal Healthcare do just fine and are in great health. and No, they don’t “pile up at the border” to get health care.

  • So far i am healthy, but my dad had hip replacement, triple bypass, valve job, pacemaker, eye surgery and it was all reasonable and “free”. We have also had 3 c-sections when we had our kids. You can switch doctors anytime. Maybe these people live in rural areas. I am in a big city with lots of hospitals. My mom had full chemo and radiation and a mastectomy. All “free” and quickly received.

  • It’s simple all one has to do is watch the border states here in the states. They fill up with snowbirds most of whom are Canadian. The rest cross the border into the northern states to get health care. The proof is right there just ask a real Canadian. I’ve spoken to dozens and they all say Canadian health care sucks.

  • Absolutely spot on! There is no accountability in Alberta, healthcare is a joke and life very cheap indeed!

    Check this out:

    https://www.facebook.com/pages/Canadian-Health-Scare/1525899484351077?ref=aymt_homepage_panel

    Check this out:

    http://www.gmrose.co.uk/appendectomy/intro

    For me, I cannot get out of this province fast enough!

  • I understand this! I can’t even get a Specialist to accept my GP’s referral. Herniated L5 S1 n SI Joint Dysfunction. Can’t work. Can get physio, can, toilet lift, tub handle, homecare…. Medical care=No. Free Healthcare?