A medical billing industry representative told the Times that providers are unveiling new fees because the Patient Protection and Affordable Care Act “has shifted so much responsibility for payment from insurers to patients and patients do not pay as reliably as insurers.”
Actually, the rise of high-deductible plans pre-dated Obamacare. They are increasingly being sold on and off the Obamacare exchanges and are being offered more commonly by employers to their workers. Indeed, about a third of companies say they intend to offer only a high-deductible plan to their employees next year.
For providers, any payments they can collect at the point of service rather than waiting for the insurer to pay is a win, because industry surveys show it becomes much more difficult for hospitals and doctors to collect the patient responsibility portion once the patient walks out the door. Billing consultants are urging providers to collect fees upfront whenever possible.
What worries consumer advocates, according to the Times, is that providers are coming up with hidden fees and trying to collect questionable point-of-service payments, particularly for preventive services that are supposed to be covered on a first-dollar basis under ACA rules. For example, the Times reported that a Chicago business student had to pay $300 out of pocket for a routine physical because extra blood work associated with the doctor's visit was not covered by insurance.
A Crain's Chicago Business reporter told us that her dentist's office recently tried to collect part of the fee upfront for a routine cleaning, saying that was the amount patients typically owed after the insurer paid the bill. The reporter refused to pay, telling the dentist's office to submit the bill to the insurer. But in some cases, providers refuse to provide the service unless the patient agrees to pay at least a portion of the bill at the time of service.
This is not the first we've heard of providers and insurers trying to skirt the rules for covering services. There have been widespread complaints for several years about consumers having to pay hundreds of dollars for recommended colonoscopy screenings for colorectal cancer, a preventive service that is supposed to be covered with no deductible or cost-sharing.
If providers are establishing new charges because of increased patient cost-sharing, and insurers are doing nothing to protect their members from these questionable charges, that raises the question of whether anyone is looking out for the consumer in the convoluted, confusing U.S. healthcare system.
Harris Meyer contributed to this article.
Follow Bob Herman on Twitter: @MHbherman