|The problem is the medical service provider is trying to |
make the patient responsible for Medicare's conduct.
October 13, 2016 (the local incident)Per the doctor's written instructions, I went to an imaging/diagnostic center for chest/lung X-rays. I had been to this place before a couple years ago and there hadn't been any problems.
As with most medical service providers, I was first directed to the Hallowed Contract Signing Room. And there is where everything fell apart...
They placed a contract in front of me that basically said (paraphrasing):
- We will take the X-rays.
- We will bill Medicare.
- Medicare will then decide if the X-rays were medically necessary or not.
- If Medicare unilaterally decides the X-rays were not necessary and refuses to pay, then you must pay instead.
- If you refuse to sign this contract, we will refuse to do the X-rays your doctor ordered.
- That Medicare no longer considers a doctor's word or judgement good enough.
- That Medicare sometimes reneges on payments and that I am supposed to protect the imaging/diagnostic center from this by agreeing to pay them myself in such cases.
I felt sympathy for the woman at the desk, I knew she was just following orders.
So, is this a Medicare issue or is this an imaging/diagnostic centers issue? Or maybe it is only this one service provider that is pulling this stunt and Medicare is being falsely accused? [Incident is sorted out in next section.]
As a side note, I asked for a copy of the contract to show the doctor as to why I didn't get the X-rays and the imaging/diagnostic center flatly refused.
The National ProblemSWAG CONTRACTS.]
Continuation and UpdateI called the doctor's office. Yep, apparently most imaging/diagnostics centers are now pulling this stunt.
A patient being held responsible for a bill, because they falsely claimed they were insured, is indeed as it should be. However, a service provider attempting to force a patient to be held responsible for an insurer's breach of contract, bureaucracy, bad faith conduct, mistakes, or even just a misunderstanding is not.
The contract is between the service provider and the insurer, it is their responsibilities to understand and agree to the terms. Any attempt by a medical service provider to make a patient responsible for an insurer's actions is, to me, an essentially bad faith action on the part of the provider. Basically, the medical service provider is extorting the patient to insure the provider against the actions of the insurer, the threat being the withholding of needed medical care if the patient refuses to do so. In other words, patients are being forced to sign under duress.
Is it any wonder most countries think America has the most corrupt Medical Establishment on the planet? Our government keeps trying to fight it. But the greed and corruption is so entrenched, ingrained, embedded, and widespread (there are media reports almost daily on the subject) that nationalization of the medical industry may indeed be the only answer.
There would still be private sector medical professionals, but the government would be the single insurer and the only legally responsible payer. And it would be illegal for any private sector medical entity to try to coerce a patient into signing any sort of contract. Proof and authentication of identity would be all that is required, preauthorization for medical procedures implemented on an as needed basis. Premiums would be based on income. Service providers (including hospitals) would no longer have to worry about being paid. Patients would no longer have to worry about being thrown into financial hardship or outright bankruptcy.
Meanwhile and for the time being, if a service provider hands you a contract such as the one I described in the above bulleted list.... Inform them that if they are unwilling to trust the insurer, then neither are you. You will no doubt immediately be thrown out, but at least you wont be a patsy.
You might try suggesting the service provider get preauthorization from the insurer. However and for some unknown reason, there are apparently some medical service providers who refuse to do this, the initially mentioned imaging and diagnostic center being one.
On a personal note, I am aware versions of this situation have been going on for decades. I have always circumvented the problem by simply adding the following sentence directly above my signature in caps:"ONLY PROVIDE 100% COVERED SERVICES ONLY". The service provider then gets everything pre-authorized and there has never been a problem. As to why this particular, aforementioned imaging and diagnostic center is pulling this new stunt is beyond me. I live in a small town, hopefully the situation isn't as bad as the doctor's office has indicated and I can find another, more ethical place.
A Bookmarks Reference List of Patients Bill of Rights ResourcesI figured while I was at it, I might as well compile a list of resources regarding the rights patients are legally supposed to have. All listed websites are government or other well-known, reputable sources. All links go directly to the website's patients rights page. This list is just starting out and will be added to from time to time. I also intend to add resources for the more populous states. I might throw in some legal and publicity resources as well.
- MedlinePlus, from the U.S. Library of National Medicine.
- HealthCare.gov, your rights under the Affordable Care Act.
- Medicare.gov, your Medicare rights.
- The Medicare Beneficiary Ombudsman. , a resource for filing complaints, grievances, appeals, etc.; in other words, a place to rat out medical service providers. The page also promises to provide information, help, assistance, and other services. The page is apparently also the starting point for when you need to deal with Medicare's own shenanigans.
- CMS.gov, Centers for Medicare & Medicaid Services. The particular link I provided has to do with Consumer Information & Insurance Oversight. The page may not especially look it, but these guys are your friend. Sometimes, out of the blue and without any action on your part, they will send you notices a particular medical bill from a service provider or insurance entity is not valid and that you don't have to pay it. This website is definitely worth prowling around when you have the time.