Good look in on how out health system drives us… to places we did not want to go.
Again, those who live in countries with universal health care can chuckle. Others can simply cry.
What is a surprise bill?
Health insurance in the US has migrated toward a “health maintenance organization” system. Doctors and laboratories who are in network agree to the fees allowed by the insurer, and are paid by the insurer. Doctors and labs that aren’t in network don’t accept the insurance fees, and aren’t paid by the insurer. Bills for those services go to the consumer.
Most consumers know to check the in-network status when making an appointment with a new doctor — or I help them by consulting insurer directories before they sign up for insurance.
How then can surprises happen?
- The doctor orders lab work and uses a lab with which he has a relationship, but the lab it out-of-network with the insurer. Doctors don’t know and often won’t check, so the patient…
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One of our typical setups
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