Doctor’s Tip: Stand up for your financial rights when dealing with the American health care system
In the early 1970s the American Hospital Association developed a Patient Bill of Rights. This included rights such as “understandable information concerning diagnosis, treatment and prognosis” and a “smoke-free environment.”
We now live in an era of exorbitant medical costs, with too many people who don’t have insurance coverage or have high deductibles. Therefore, patients need a financial bill of rights. Elisabeth Rosenthal, M.D., is a physician and journalist who wrote a book that came out a few months ago called “American Sickness, How Healthcare Became Big Business and How You Can Take It Back.” She wrote an opinion piece in the April 29 Sunday Review section of the New York Times, with the title “A Financial Bill of Rights — Patients need to be protected from unfair charges.” She recommends that patients are entitled to the following:
1. “The right to an itemized bill in plain English” so that patients can “detect and refute improper charges.” Medical bills are often not itemized, often include language and abbreviations that lay people can’t decipher, and studies show that 30 to 50 percent of medical bills contain errors.
2. “The right to never receive a surprise out-of-network bill.” This refers to, for example, the hospital being in network but the anesthesia or radiologist isn’t, and the patient is unaware of this until they get the bill.
3. “The right to accurate information about the provider network in insurance plans.” This addresses the problem of some doctors being in network for certain procedures but not for others (e.g. gastroenterologist in network for polyp removal but not for screening colonoscopy).
4. “The right to a stable network.” If a doctor or insurer stops participating in a network within the year after an insurance policy is purchased, the patient should still be billed as an in-network patient.
5. “The right to be informed of conflicts of interest.” Some doctors have a financial stake in testing facilities (e.g. orthopedists owning their own MRI) or procedure facilities such as outpatient surgical centers, which can lead to unnecessary tests and procedures.
6. “The right to be informed in advance about any facility fees.” For example, if a procedure is done in a doctor’s office there is usually no facility fee, but if it is done in the hospital there is. Costs differences associated with different options are seldom discussed with patients.
7. “The right to see a price list for elective procedures.” Informed consent “should include financial liability as well as medical risk.”
8. “The right to be informed of cheaper options.” For example, months of hospital-based PT are usually ordered following hip replacements, but patients should be told that another, much cheaper option is to have a few instructional sessions and then do the exercises at a gym.
9. “The right to know that a disputed bill will not be sent to a collection agency.” Dr. Rosenthal points out that hospitals often threaten patients in a way that would be considered extortion in any other business.
Years ago medicine was a paternalistic profession, and patients did whatever the doctor told them to do, without asking questions. Currently practice of medicine is more of a partnership between doctor and patient, with various diagnostic and treatment options being discussed with the patient and a joint decision made before proceeding. Unfortunately, finances are often left out of doctor-patient discussions, and this contributes to the high cost of our health care system and to financial hardships for patients. So ask questions such as whether you really need that MRI or other expensive tests, and about less expensive treatment options such as having a minor procedure done in the doctor’s office rather than a hospital. Stand up for your financial rights.
Hospitals charge a lot because they can get away with it. If you receive a hospital or other medical bill that seems unreasonable or that you don’t understand, you can contact me at 379-5718 and I will do what I can to help you, at no charge.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. Dr. Feinsinger is partnering with Compass Peak Imaging to access heart attack risk with a specially-priced carotid IMT (much more sensitive than regular ultrasounds like Lifeline Screening) through May 17 (check the dates in the ad in the P.I.), with free discussion about results and about heart attack prevention by Dr. F. on May 17. He is also available for free consultations about heart attack prevention and other medical issues. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.