I’ve noticed this — I’ve been getting all kinds of charges for things I was never charged for before! Gee, if only we had politicians that could actually fix this:
Leo Boudreau of Massachusetts was thrilled to find a psychologist in his insurance network to treat his teenage daughter for emotional stress related to a medical condition. The therapist worked out of a local hospital.
But he was surprised when the bill for each visit contained two charges: the approximately $100 he expected to see for the therapist — and a similar fee for the room, which was not covered.
“How could it be that the doctor was in network and the hospital was in network, but I had to pay separately for the room?” Mr. Boudreau said.
As insurers ratchet down payments to physicians and hospitals, these providers are pushing back with a host of new charges: Ophthalmologists are increasingly levying separate “refraction fees” to assess vision acuity. Orthopedic clinics impose fees to put an arm in a cast or provide a splint, in addition to the usual bill for the office visit. On maternity wards, new mothers pay for a lactation consultant. An emergency room charges an “activation fee” in addition to its facility charges. Psychologists who have agreed to an insurer’s negotiated rate for neuropsychological testing bill patients an additional $2,000 for an “administration charge.”
In some cases, such as refraction, the services were never typically covered by health insurance but had generally been performed gratis as part of an exam. In others, the fees are novel constructs. In any case, as insurers and providers fight over revenue in an era of cost control, patients often find themselves caught in the middle, nickel-and-dimed.
Some of the charges come directly out of patients’ wallets at the time of treatment and catch patients off guard. And if they do not write a check for the refraction fee, for example, many doctors will not dispense a prescription for the glasses.
When Laura Gottsman took her 15-year-old daughter to the Palo Alto Medical Foundation in California last month with a broken arm, she had to sign a special form agreeing to pay for the sling if the insurer did not. A sling charge? Both of her daughters previously had broken arms set at the clinic, and she had not encountered such forms or charges.
“There really wasn’t an option to say, ‘No, I don’t want the sling,’ ” she said. She had not yet received the bill. Liz Madison, a spokeswoman for Sutter Health, which owns the clinic, said that a sling counted as a type of durable medical equipment and that patients typically paid for such items.
Cindy Weston of the American Medical Billing Association, an industry group, said it was up to physicians to decide what to include in their principal payment and what merited an extra charge. She said they now “may be forced to charge” for new services because the Affordable Care Act “has shifted so much responsibility for payment from insurers to patients” and patients do not pay as reliably as insurers.