Apparently, we still have a way to go in health care.
Witness Eric’s Explanation of Benefits (EOB) from an Emergency Room visit. He was at an In Network hospital but had services performed by an out of network pathologist, anesthesiologist and radiologist.
A trifecta of “RAP” services!
The difference between the full ‘retail’ and the insurer’s negotiated discounts end up being the patient’s “surprise” responsibility.
And, according to a Kaiser Family Foundation report, “as many as 26% of admissions from the emergency room resulted in a surprise medical bill.” Read more here.
Policymakers on both sides of the isle are working on solutions. That there’s push-back from certain stakeholders shouldn’t surprise you. (But who, might.)
In the meantime, some insurers simply hand out small print warnings to their members telling them to be wary of this practice. (Like negotiating in the ER is a viable option!) Others take a more pro-active approach and settle directly with the provider, so the member never even knows there’s been a problem.
That kind of advocacy doesn’t illustrate well on a premium spreadsheet.
P.S. If you’ve been a victim of “RAP” charges, you might want to read this article from Health Affairs.
