Jackson Jambalaya

Medical lobbyist at work sending this bill back for reconsideration. Take all lobbyist out & shoot them!

I got wind of a medical expense to the tune of $ 9500.00 for a DNA analysis of a tumor. It showed up on my quarterly Medicare statement. I'm on a fixed income & can't afford this. I have Medicare, Blue Cross Blue Shield, & a veteran qualified for VA Medical care & I still see charges like this. Go figure.

Imagine the IN NETWORK facilities that are owed hundreds of thousands of dollars from the insurance companies that Mike Chaney's office won't hold accountable. I'm talking rural facilities.

I had no idea this even existed. It sounds like a great idea and puts consumers on equal footing regardless of who provides the service.

Of course some providers could just opt out of direct billing to the insurance company and try to collect payment from the patient. The law already says if the patient received the benefit then the service provider must be notified. A provider like an air-ambulance that has a history of high balance billings is going to have to weigh out if it is better to settle for what the insurance company says is reasonable and take just that versus what they've actually been able to squeeze out of their clients.

I can see if a lot more people know about this and take advantage of it, some services in rural areas that are less frequently used with significant down time between clients will be discontinued. Insurance company set reasonable rates will need to be set at a level that ensures state-wide coverage and not just in urban areas.

Mr. Cheney's tenure as Commissioner of Insurance has been one of Mississippi's political bright spots. I commend him for bringing this unlawful practice into the light and seeking the power to enforce the law on behalf of consumers.

This is an important issue for everyone.If you are on a company group plan, an individual plan or on Medicare you are subject to balance billing. Your child has an ankle injury, the ortho doc puts them in a boot. Oops the boot maker is not in your network so it’s not covered.

So, is the insurance commissioner saying that it is illegal for an anesthesiologist who has no contractural agreement with the insurance company to charge the patient the difference between their private fee and the insurance company fee?

If I have done the research to know that the hospital and doctor performing my surgery are in-network. Then I should not be receiving anesthesia from an out-of-network anesthesiologist. These "surprise bills" are very common and can leave patient with a large bill.

@ 9:26 AM: Air Ambulance companies got Congress to pass legislation which permits them to balance bill patients for the retail price of their service. North Dakota passed a law to end the practice and had the law struck down by a federal court which said States cannot regulate air ambulance services.

@ 10:49 AM: Balance billing only arises in situations where a patient is insured. If the physician is in network or accepts that insurance that physician agrees to be reimbursed at the insurance carriers approved fee for service. The insured is a third-party beneficiary to that agreement. The physician's effort to balance bill the patient after providing the service violates the agreement with the insurer and Mississippi law. All the Commissioner is saying is that he wants the authority to enforce the law on behalf of patients who file complaints.

@10:49 When you go to an In-Network hospital, you expect the services received in that hospital to be considered In-Network. Patients shouldn't be expected to ask every doctor treating them if they are in-network.

@10:49 Only if that anesthesiologist accepts insurance assignments. In other words, if that anesthesiologist agrees to direct bill the out-of-network insurance company and accept payment directly from the insurance company, then yes they are not allowed to bill for more than the standard rate for the procedure.

Of course, any provider that doesn't do direct billing for covered procedures is going to have a hard time staying in business. The alternative is to have the insurance company send the check directly to the patient and then bill the patient for the full amount. The confusion and frustration in that situation would be massive.

Speaking of Air Ambulance...this came up on this blog a couple of weeks ago and I was roundly chastised for criticizing the commercials for this ripoff.

As a result, I contacted the one serving the Delta and got answers from the home landing strip over in Arkansas (or it might have been Louisiana). And yes, according to my posts here, they are NOT dispatched by first responders unless you have a paid for contract with them.

The person on the other end of the conversation hem-hawed around for an hour about the value of their services and rapid response. But, fact is, if an ambulance, county deputy or volunteer fire department responds to your remote, rural emergency location in northeast Mississippi, and your situation is deemed critical, they will call air ambulance out of Jackson, not some outfit based in rural Louisiana. So much for your paid up transport-contract.

It’s evident that some making comments do not understand the issue. This bill is important and everyone is subject to being balanced billed.
Similar legislation has been padded in many states

Get SUM Mike! Why do I have to pay $350 to GI Associates, in network, prior to a procedure and that payment NOT show up my EOB? Something is fishy in Denmark! But what are you to do if NO ONE has enforcement authority for balanced billing by a provider?

When you look at what Medicare pays for various procedures it becomes evident to those who pay attention just what the procedures are worth and those with private insurance as a rule pay a great deal more than the fair price. And anesthesia in particular is a gold mine to the doctors who are not hospital employees but why are they not employees of the hospital?

All in all it has appeared to me that since the time of Evelyn Gandy the commissioner has been primarily concerned with protecting insurance companies for the same reason that Medicare has all the additional optional part, i.e., money, of course. Individual voters don't care about rip offs by government until it affects them individually but then the government doesn't pay any attention to individuals when they have a problem. Well the average individuals anyway.

But then it's just more corruption. No big deal.

We had this happen to us years ago. We used an in network OB and in network hospital. Our child was born premature and the NICU physicians were their own private group within the hospital. BCBS covered the delivery and nursery costs just as we had planned but we were left with a huge NICU bill.

@9:45 I bet I could tell you the hospital. It's been over 20 years, but that is our exact story. I wrote the doctor a letter explaining the circumstances and he very graciously killed the extra bill. It was very shocking and very unfair, considering we had taken great care to make sure the hospital was in network.

@5:16 I've had this happen a couple of times. The provider will run my information through BCBS and note that I still have $500 of my $1,000 deductible to meet. They will make me pay the $500 up front. The EOB only shows what the insurance company is responsible for. If everything works out right the EOB should show $500 of the procedure applied to your deductible, but the insurance company has no way of knowing or even caring what you paid to the doctor.

You'll just have to reconcile the provider's bills with the EOB and make sure what you paid equals what the EOB says is the patient responsibility. Never trust the doctor's office to do everything right.

What really is fun is when more than one provider is involved. I've had to pay the remaining deductible to two different providers and then fight for a refund later when one of their claims wasn't reduced by the deductible.

Go to the Canada model.

I didn't know I had a choice. Anything insurance doesn't pay, I wind up paying unless the provider 'agrees to accept assignment'.