Dec 032012

Published Sat, Dec 01, 2012 12:00 AM

The N.C. Medical Society and a hospitals association are pointing angrily these days to the contracts hospitals have with health insurer Blue Cross and Blue Shield of North Carolina and crying, “Foul!”

If the groups want patients on their side, this is the wrong fight to pick.

Under the contracts, BCBS has been having to pay multiple bills for services associated with medical scans, bills for things like gowns, IVs, exam rooms. The extra bills come about when several scans are done at the same time, but the hospitals charge for those services per scan. That’s ridiculous.

And the state Department of Insurance has said so in a new ruling that BCBS doesn’t have to pay multiple bills for the services any more.

If a patient wears one gown through four scans, the bill should be for one gown. And so on with the other services that go along with the tests.

BCBS still pays doctors who read the scans by the number they read. So the hospital charges would appear to be just an extra charge thrown in to boost the bottom line.

Hospitals defend the practice by saying their contracts with the insurer allow them to do what they’ve been doing. That’s not much of a defense. The N.C. Medical Society said, “Patients and their doctors do not stand a chance if giant insurance companies can dictate how health services are delivered.”

This doesn’t seem to be about how services are delivered. It seems to be about how hospitals charge insurance companies several times for what are for them one-time expenses – charges that ultimately are paid by policyholders. Perhaps the society is indeed worried about insurance companies having too much influence over care by dictating what they’ll pay for and what they won’t pay for, but in this case, the clarity of the unfairness is plain.

The hospitals also aren’t helped by the findings in a series this year by The News & Observer and The Charlotte Observer that showed nonprofit hospitals have been inflating prices for drugs and procedures sometimes as much as 10 times over cost.

Hospitals on occasion try to justify those prices by claiming they have to recover the money they lose treating people without insurance who can’t pay for their health care. Such “cost-shifting” is an unfortunate aspect of a health care system where too many people lack insurance coverage – a problem that federal health insurance reform is intended to address.

But forcing BCBS, which has about 75 percent of the business in North Carolina, to pay for what are in effect phony charges amounts to deceptive accounting. The Department of Insurance made a pro-consumer call here, in addition to a pro-BCBS call, and the right call it was.

via Win for patients – Editorials –


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