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In or out of network? Patients and doctors want to know, but it can be a mystery.
“I’ve been seeing my cardiologist since 2016 and insurance company’s website shows he is in my network but recent referral is denied and the denial letter says he is out of network,” the Tweet said.
Another tweeted: “Companies that are dedicated to help you navigate your healthcare insurance benefits struggle just as much as you would. Me- “Is this provider in my network?” Them- “One moment, let me check. Actually, let me place you on hold.” [15 mins later] Them- “So we’re not actually sure…””
A Colorado therapist told us she was “paneled by surprise” — suddenly receiving a flood of patients who said they had been told she was in network, without having received a contract. A New York area therapist told a similar story.
What doctor is in your network, and who’s out? And if you’re a doctor, are you in or out? And how can you tell?
The in-network and out-of-network muddle is getting more muddled, from all reports. It has been confusing since we first started studying the healthcare marketplace in 2011, and yet it never seems to improve.
This came up in the context of our recent post about therapists who have been unable to terminate their Empire Blue Cross contracts, despite repeated efforts.
North Carolina hospitals have sued thousands of their patients, a new report finds
North Carolina hospitals — led by the state’s largest public medical system — have sued thousands of their patients since 2017, according to a new analysis that sheds additional light on the aggressive tactics U.S. hospitals routinely use to collect from people who fall behind on their bills.
The report, produced by the state treasurer and Duke University School of Law researchers, and related patient interviews offer harrowing accounts of people pursued for tens of thousands of dollars and often surprised by liens that hospitals placed on family homes. In some cases, spouses were targeted after their partners died. In others, patients interviewed by researchers said they’d been surprised to learn about property liens only after they tried to sell their homes or after a parent who owned the home died.
“I know my house will never be mine. It is going to be the hospital’s,” said Donna Lindabury, 70, whose home was targeted by Charlotte-based Atrium Health, which won a $192,000 judgment against her and her 79-year-old husband over his 2009 heart surgery. Interest on the debt represented more than half of the couple’s balance.
Tough times strike private equity hospital staffing companies
Yet another hospital staffing company primarily owned by private equity investors appears to be in trouble, adding to the pile of stresses in the sector, according to news reports. “Sound Inpatient Physicians Inc. has hired PJT Partners for debt advice as the hospital-staffing company grapples with earnings pressure, according to people with knowledge of the situation,” Bloomberg reported on Aug. 4. Sound, based in Tacoma, Wash., provides staffing for hospitals and centers providing short-term care to patients, including intensive care or emergency medicine. The private equity firm Summit Partners acquired Sound in 2018; UnitedHealthCare’s Optum group was also an investor.
This bad news for Sound comes after the sudden and spectacular failure of American Physician Partners, another private equity company, which collapsed in late July, failing to pay its employees and failing to find a buyer to stave off collapse. Other big private-equity-owned agencies are also struggling, with bankruptcies and tense discussions with creditors, according to news reports.
Why is this happening now? At least part of the trouble these companies are encountering is downstream from the federal No Surprises Act. The act is an attempt to end the practice that has fattened the bottom lines of staffing companies: Staff an emergency room with doctors who are not in any network, and then send massive surprise bills to patients who thought they were in an in-network hospital. No Surprises pretty much ends the foundation upon which these companies built their businesses.
This doctor says corporate medicine is a threat to public health
Dr. Mitchell Louis Judge Li, an emergency room M.D. who is the founder of the “Take Medicine Back” Facebook group and newly birthed nonprofit of the same name, is battling against the corporate practice of medicine (C.P.O.M. is what he calls it). If medicine is corporatized, he believes, the patient-physician relationship is spoiled. What is corporatization? We talked on Zoom recently, right after the spectacular collapse of the American Physician Partners, a medical staffing group, which left a number of doctors and other employees without jobs, without paychecks and without their protective medical malpractice insurance. This transcript of our conversation has been lightly edited for length and clarity.
Jeanne Pinder
So, Mitch Li, who are you? What do you do, and where do you do it?
Mitch Li
I’m a board-certified emergency physician. I live in western North Carolina now, where I practice as an emergency physician. I do work full-time at the V.A., but I am not speaking on behalf of the Veterans Administration. I also work additional shifts in the community as an emergency physician. And I’m the founder of Take Medicine Back, which is a public benefit company that was formed to raise awareness of the corporatization of the profession of medicine, and the healthcare system.
What we’re reading
Murky doings: How pharmacy benefit managers make secret deals to take more money out of the system. Those admin fees are a percentage of the price of the drug — which means there’s pressure for the drug to cost more. Bloomberg.
American Physician Partners is not dead after all. Emergency Medicine Workforce.
FTC and HHS sent a stern letter to 130 hospital systems and telehealth providers telling them to quit tracking users on website or app with trackers like Meta’s (Facebook) pixel and Google’s analytics. Freshpaint.io.
AdventHealth, a Florida-based nonprofit hospital company, sued MultiPlan, accusing it of price-fixing in an anti-trust case. Fierce Healthcare.
The U.S. Department of Labor is alleging UnitedHealth Group denied thousands of patients’ payments for emergency room services and urinary drug screenings. Fierce Healthcare.
How UnitedHealth came to be: Decades of policy choices led to this colossus. American Prospect.
Sexual health and heart health for men, in one pill, prescribed online. What could go wrong? MedCity News.
White people feared Covid less after hearing that it struck black and brown people hardest, research finds. NPR.
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