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

 

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

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A former physician reveals how to avoid surprise medical bills

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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.

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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
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by Barbara J. Youngberg
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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.

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

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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.

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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.

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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.

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“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
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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
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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.

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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.

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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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14 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.