|The problem is the medical service provider is trying to |
make the patient responsible for Medicare's conduct.
October 13, 2016 (first local incident)Per doctor's written instructions, I went to an imaging/diagnostic center (name temporarily redacted) 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.
October 27, 2016 (second local incident)Per doctor's written instructions, I went to a local blood lab (name temporarily redacted) this morning. While in the back room, they came in with a contract saying certain medical codes were missing and I would have to agree to pay for what Medicare wouldn't pay because of the missing codes. I declined, at which point they said they would contact the referring doctor's office and get the codes.
They then came back and said they had got the codes and proceeded to take my blood. I never had to sign anything and all appeared well.
When I got home, it occurred to me to call the doc's office to see if the blood lab really did call them and get the codes.The Doc's Office Said They Never Received Any Such Call. They further said they would look into and deal with it, and that I would not be responsible for any bills.
I'll wait to see how this sorts out before acting further. I never signed or agreed to anything. So if I do receive any sort of bill, I will perceive it as attempted fraud on the part of the blood lab and will indeed name names, unlike my still withholding the name of the imaging/diagnostic center.
When I first reported about this second incident, I received input from others stating such things as...
- They have been nothing but trouble for people with Medicare or PPO health insurance.
- Credit card numbers demanded in advance before agreeing to do blood work.
- Collection agencies being used on unwarranted/disputed bills.
November 15, 2016 update: still no bill received.
Early November, 2016 (third local incident)Per doc's referral, I went to an eye doctor place (name temporarily redacted) and made an appointment. After making the appointment, I then perused their frames selection. The prices were literally double to triple the prices that can be found elsewhere, presumably the lens prices would be equally exorbitant.
The place was packed with patients/customers, noticing that caused me conflicted emotions...
- On the one hand, I am pro capitalism. If a business entity discovers an unending supply of customers who voluntarily pay double to triple the going rate for a product or service, then you really can't fault the business entity for taking advantage of that.
- On the other hand, pretty much all the patients/customers there were extremely old people who just plain no longer apparently had the mental faculties to know any better or the ability to realize what was going on. I'm not an attorney, but this could easily be perceived as a case for elder abuse. Most insurance does not pay for frames and lenses, only for the exams.
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 such case.
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 they can find a more ethical place to refer me.
|This Has to Stop|
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. I might add to this list from time to time.
- 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.
- California Department of Public Health (CDPH), the go-to page for filing medical complaints in California.
- Office of the Patient Advocate (OPA), another go-to page for filing medical complaints in California.