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Medical costs

U.S. patients with insurance charged higher fees than non-insured

Friday, April 25, 2014 by: J. D. Heyes
Tags: medical costs, health insurance, patients

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(NaturalNews) A recent investigation by a local news team uncovered evidence that a growing number of California physicians have been charging patients with extra health insurance fees that go to cover everyday office expenses, a practice that is illegal under most healthcare policies.

Investigative journalist Charles Feldman of KNX reported that some doctors have said they need to charge the extra fees because the regulatory costs of running a practice have skyrocketed over the last decade -- costs that are made worse by Obamacare requirements.

In fact, he reported, some physicians cited the Affordable Care Act specifically, saying the law's myriad of new rules and requirements raises costs for them and for patients.

However, critics of the fees say that using the Obamacare law as an excuse doesn't cut it. One of them is Anthony Wright of the consumer watchdog group Health Access California.

The practice may be spreading

"The Affordable Care Act has another provision that puts a limit on how much your premium can be spent on patient care, rather than administration and profit. So, again, having an outside fee that is for administration is in violation in the spirit of the law, which is to try to limit the amount of money that's spent on administration profit, and really target those dollars towards patient care," Wright said.

Feldman reported that, for the vast majority of Californians who have health insurance coverage, which amounts to more than 20 million residents, adding extra fees beyond the usual co-payments and co-insurance is illegal under California law.

"Health plan members cannot be charged administrative fees when they visit an in-network provider," Shelley Rouillard, the director of the California Department of Managed Health Care, which regulates the vast majority of health plans offered in the state, told KNX.

Meanwhile, the California Academy of Family Physicians said officials there have not heard of the practice, and the organization therefore does not have a policy dealing with it in place.

While some doctors have long charged extra fees for services such as filling out school forms, Feldman says that new fees have been popping up recently and are being applied in the form of a flat fee, ranging from a few hundred dollars a year to more than $1,000 per annum, regardless of whether or not a patient uses a particular office service.

David Doyle, CEO of a major physician billing consulting firm in Michigan, says doctors in other parts of the nation are also beginning to tack on these extra fees.

"There's definitely a growing number of physicians across the country that are moving in that direction," Doyle told Feldman. "And it should be noted that, up until several years ago, physicians did charge for certain services that were not covered, if you will, by insurance carriers such as preparing for school athletic forms, school participation forms, disability forms, things of that nature. Those were items that they had historically charged for -- they're now expanding that into a much wider area."

It is not illegal under some plans to charge the extra fees because they are not covered by state law prohibiting the practice, KNX reported. But it is nearly impossible for a patient to discover whether their insurance company permits the fees, because the contracts are between insurers and physicians, which leaves the patient having to rely on the doctor's word that such fees are permissible.

But ultimately, many doctors won't get paid

Separately, a number of doctors' organizations have expressed concerns that their members won't be paid because of an unusual 90-day grace period for government-subsidized health plans under Obamacare rules. They are urging doctors to check each patient's insurance status before every visit.

"This puts the physician and their patients in a very difficult situation," said Dr. Ardis Dee Hoven, president of the American Medical Association.

"If a patient is being treated for a serious illness, that requires ongoing care," she said. "The physician is having to assume the financial risk for this. That's the bottom line."

As noted by Kaiser Health News:

If an enrollee in a subsidized plan falls behind on their premium payments, the Affordable Care Act requires insurers to cover their medical bills for 30 days.

But for the next 60 days, insurers may "pend," or hold off paying the claims -- and ultimately, deny them if the patient doesn't catch up on his premiums. That means doctors don't get paid for their services. If the insurer ends up canceling the policy after 90 days, doctors can bill patients directly but may face difficulty collecting.





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