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No Surprises: Hospital Agreements

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We could all use a break
Published
Sep 21, 2022 10:20 PM
Last updated
Sep 25, 2022 5:40 AM
Topics
Ethics
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    On March 20th, 2022, in the finals of our spring soccer season, I broke my nose on a 50-50 header.

    Being my first broken bone—yes, ever!—I quickly chose to have it seen professionally. Alas, the Urgent Care told me they don’t do X-rays of the nose, and sent me to the nearby Honor Health hospital.

    Upon arrival, the first thing I asked for was a list of prices for services—but was told they had none. Okay.

    Fast forward through 45 minutes of playing “I Spy” with my wife in a fluorescent hospital room (aka, waiting to be seen), a few fleeting moments speaking to a doctor, 3 X-rays of my nose, more waiting, a few more fleeting moments, and an admin tech wheels a tablet in to get my signatures.

    There are no “good faith” pricing estimates anywhere. I ask to know how much the visit has cost me. He says there’s no way to tell. Okay.

    I sign the documents—Conditions of Admission, HIPAA Notice of Privacy, Patient Rights, Financial Agreements, Out of Network Physicians—thinking I have no other choice. (Spoiler: I did.) I had decided to wait and see what the charges look like. After all, I’ve successfully disputed medical bills in the past and gotten them reduced by thousands of dollars.

    Fast forward a few weeks later, and I get the bill in the mail: $2,562.

    Then I get another one, from Envision Physician Services: $445.

    I call Honor Health billing and state I didn’t consent to these charges. I had asked for a good faith estimate, and hadn’t received one. They say I did consent to pay the charges by way of signing the Financial Agreement. Sure enough: “…the undersigned accepts full financial responsibility for all items or services, which are determined by the health care plans not to be covered.”

    But, they tell me, they can apply a self-pay discount if I’m not using insurance. I’m not.

    While waiting for my adjusted bill, I do some more research and discover the No Surprises Act, which prevents medical bills starting in 2022 from exceeding $400 more than the “good faith” estimate you’re provided with during your visit.

    CMS.gov also states “You aren’t required to sign the [notice and consent] form” and I’m going to extend that further:

    In retrospect, I don’t believe I was “required” to sign any of the forms that day in the hospital. What would have happened if I’d refused to? As I told them, I was happy to review any charges right then and there, and would have negotiated and paid something.

    But, I signed, and now I’m responsible for paying.

    My lesson learned is this:

    In the future, I won’t sign a financial agreement after getting emergency care at a hospital. I’ll continue to act in good faith and pay reasonable rates for services rendered, but I’ve learned that signing anything with a hospital is a sure-fire way to guarantee you’ll owe more than you expected—and I’m not into that game.

    It’s not to say I want to unfairly take advantage of hospitals and their contracted physicians. They provide crucial services and deserve to be paid for their work. It’s just that the way they bill is nightmarish, only complicating the process for everyone involved.

    It’s no secret American healthcare is in dire need of a drastic overhaul, of innovation and disruption. Startups like Forward, Capsule, Turquoise, and Vori, along with locally owned medical providers, are helping pave the way toward a “not-so-distant future where prices have menu-like clarity at a fair market rate,” in the words of Turquoise’s About page.

    I’m excited for this future.

    Originally published @September 21, 2022

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