{"id":1191971,"date":"2023-03-12T07:11:08","date_gmt":"2023-03-12T11:11:08","guid":{"rendered":"https:\/\/bugaluu.com\/news\/i-got-scammed-americans-describe-getting-surprise-medical-bills-via-health-care-loopholes\/1191971\/"},"modified":"2023-03-12T07:11:08","modified_gmt":"2023-03-12T11:11:08","slug":"i-got-scammed-americans-describe-getting-surprise-medical-bills-via-health-care-loopholes","status":"publish","type":"post","link":"https:\/\/bugaluu.com\/news\/i-got-scammed-americans-describe-getting-surprise-medical-bills-via-health-care-loopholes\/1191971\/","title":{"rendered":"\u2018I got scammed\u2019: Americans describe getting surprise medical bills via health care loopholes"},"content":{"rendered":"
<\/a><\/div>\n

Surprise medical bills are nothing new in the U.S., and they’ve become so commonplace in the 13 years since the landmark Affordable Care Act (ACA)<\/a> became law that Congress recently passed legislation<\/a> aimed at banning the practice.<\/p>\n

Sometimes a simple coding mishap can result in a major headache for a patient, as was the case for Anthony, a 29-year-old based out of Norwalk, Conn.<\/p>\n

When Anthony visited his doctor for a routine annual checkup \u2014 which his insurance plan through Cigna advertised as 100% covered without a copay \u2014 he ended up receiving a bill for $132.09.<\/p>\n

This was because his doctor\u2019s office coded the visit as an \u201coffice visit\u201d instead of an \u201cannual checkup or preventative care.\u201d In an effort to clear up the confusion, Anthony called both Cigna and his doctor\u2019s office, and Cigna assured him that it was simply listed under the wrong code and would be covered if the doctor\u2019s billing department corrected it.<\/p>\n

\u201cI submitted a complaint to Westmed, and they forwarded it to the billing department,\u201d Anthony told Yahoo Finance. \u201cThey rejected my request several times. According to them, the office staff had the final word on the billing code. I was able to talk to the office staff directly too, but I\u2019m not sure who was responsible for selecting the billing code there.\u201d<\/p>\n

Medical Radiology Manipulator Ludovic Foy prepares a woman before her lung cancer screening on December 16, 2021. (Photo by Pascal POCHARD-CASABIANCA\/AFP)<\/figcaption>
PASCAL POCHARD-CASABIANCA via Getty Images<\/div>\n<\/figure>\n

The experience, he added, has been “very frustrating” and time-consuming, especially after he reached out to multiple offices to try to solve the issue.<\/p>\n

\u201cWasted a bunch of time, and, frankly, I got scammed,” Anthony said. “In the end, I got no explanation why they used the wrong code, and the bill was sent to collections. It\u2019s going to hurt my credit score and in the U.S., that also means my ability to find a place to rent or even buy a house if I ever get the chance. It\u2019s the kind of thing you lose sleep over.\u201d<\/p>\n

‘They think short-term’<\/strong><\/h2>\n

A loophole in the ACA \u2014 commonly known as Obamacare<\/a> \u2014 is part of the reason why this issue persists in the U.S.<\/p>\n

Under the ACA, insurers are required to cover<\/a> preventive services such as cancer screenings, immunizations, and well-woman visits without cost-sharing, meaning that the individual receiving the services is not required to pay anything.<\/p>\n

A study published<\/a> in 2021 in the journal Preventive Medicine found that \u201cin addition to premium costs meant to cover preventive care, Americans with employer-sponsored insurance were still charged between $75 million and $219 million in total for services that ought to be free to them.\u201d<\/p>\n

\"In
In this March 23, 2010 photo, President Barack Obama signs the Affordable Care Act in the East Room of the White House in Washington. (AP Photo\/J. Scott Applewhite, File)<\/figcaption>
ASSOCIATED PRESS<\/div>\n<\/figure>\n

\u201cThe ACA specified those rules around what should be covered, but then how that\u2019s actually operationalized is left up to individual insurers \u2014 what procedure codes are covered under the umbrella of each of those services in same or spirit, who qualifies, how often they can get them is up to each individual insurer,\u201d Paul Shafer, assistant professor of health, law policy, and management at Boston University School of Public Health, told Yahoo Finance.<\/p>\n

Furthermore, last September, Judge Reed O’Connor \u2014 who previously ruled that the ACA was unconstitutional, a decision that was later overturned<\/a> by the Supreme Court \u2014 issued a ruling<\/a> that it was also unconstitutional for the ACA to require insurers to cover preventive services without copayments.<\/p>\n

If that ruling were to stand, at least 40% of adults indicated in a new Morning Consult survey<\/a> that they would not be willing to pay for a majority of the preventive services covered by the ACA mandate.<\/p>\n

While the primary goal of preventive visits is to prevent longer-term issues from arising down the line \u2014 thereby eliminating potential costs \u2014 insurers don\u2019t always see it that way, especially if a provider lists a different code on a patient’s file.<\/p>\n

\u201cThey think short-term \u2014 and I\u2019m talking in particular about the publicly-traded companies,\u201d Wendell Potter, president of the Center for Health and Democracy and former executive at Cigna and Humana, told Yahoo Finance. \u201cThey\u2019re the ones who are dominant in this area. They know there\u2019s a good chance that a person who\u2019s enrolled in a Cigna plan now might in the second half of this year be enrolled in a United plan, or even next month could be enrolled in a United plan or a Humana plan. People change jobs, and when they change jobs, that often requires that they have to work with a new carrier with a new network of doctors. And all of that goes with that.\u201d<\/p>\n

Essentially, insurance companies grow by taking market share from each other, and Potter and other industry experts refer to this as \u201cchurn.\u201d<\/p>\n

\"Former
Former CIGNA executive Wendell Potter moderates a forum on denied coverage by insurance companies March 10, 2010 in Washington, DC. (Photo by Alex Wong\/Getty Images)<\/figcaption>
Alex Wong via Getty Images<\/div>\n<\/figure>\n

Consequently, Potter said, \u201cthey choose to have a short-term focus and don\u2019t have the interest really in doing what is right for someone down the road because they are just making a bet that they likely will not have that person enrolled for a long period of time.\u201d<\/p>\n

The No Surprises Act, which became law in 2021, was intended to prevent patients from receiving surprise medical bills. However, it also comes with another loophole: The law protects patients receiving care from out-of-network providers and out-of-network emergency services, but it doesn’t apply in circumstances where the care is being provided by in-network providers, regardless of whether or not it should be free for the patient.<\/p>\n

\u201cPolicymakers and employers and the media, to a large extent, are missing some important parts of our health care system that need more scrutiny,\u201d Potter said. \u201cWe are really focusing on a few specific areas where patients in particular are at a great disadvantage. Increasingly, this is an area where we find people are having problems when there is a dispute or glitch in refusing to pay a claim.\u201d<\/p>\n

Not-so-free procedures<\/strong><\/h2>\n

Because of these loopholes, patients often find themselves billed for routine procedures that typically are fully covered by their health insurance.<\/p>\n

Several individuals, who asked to remain unnamed due to privacy concerns, shared with Yahoo Finance the forms they were required to sign in order to be seen for routine physicals and other preventive exams.<\/p>\n

In one of the forms, an individual was told that if they discussed any new or chronic medical issues with their doctor, their insurance would be billed for both an office visit and a preventive health exam.<\/p>\n

For another individual, their form indicated that if they discussed new acute conditions or a worsening chronic condition, if a diagnostic test was ordered, or if a treatment changed, they would also be subject to two separate bills.<\/p>\n

<\/div>\n

\u201cThere are a lot of gray areas but generally, those shouldn\u2019t be billed,\u201d Jenifer Bosco, a staff attorney at the National Consumer Law Center, told Yahoo Finance. \u201cIn the worst case, some providers do engage in what\u2019s referred to as upcoding where they will try to bill for things or get reimbursed at a high rate for things that really should be either preventive or should be billed at a lower rate.\u201d<\/p>\n

For example, a preventive colonoscopy meant to screen for cancer is required to be covered at 100% by health insurance providers. However, if a polyp is discovered and removed from the patient during that screening, that procedure becomes a \u201csurgery\u201d<\/a> rather than a screening and is billed as such.<\/p>\n

\u201cIt makes zero sense charging the cost of something or the cost to the patient for something while they\u2019re literally mid-procedure,\u201d Bosco said. \u201cYou can essentially bill two visits for the same time, which I think intuitively just doesn\u2019t make a lot of sense to most people. If you\u2019re going in for one visit, how can you be charged for two and also be losing that free preventive visit at the same time?\u201d<\/p>\n

According to the Preventive Medicine study, patients were saddled with a total of $12.8 million for preventive colorectal screenings in 2018, while wellness visits incurred charges of up to $73.1 million.<\/p>\n

\u201cIt feels a little bit like a bait and switch, and that\u2019s not on the doctors,\u201d Shafer said. \u201cThat\u2019s just how we\u2019ve set up the reimbursement guidelines and everything else. It\u2019s frustrating.\u201d<\/p>\n

\u2014<\/p>\n

Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on Twitter <\/em>@adrianambells<\/em><\/a> and reach her at adriana@yahoofinance.com.<\/em><\/p>\n

Click here for politics news related to business and money<\/strong><\/a><\/p>\n

Read the latest financial and business news from Yahoo Finance<\/strong><\/a><\/p>\n

From:AOL<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Surprise medical bills are nothing new in the U.S., and they’ve become so commonplace in the 13 years since the landmark Affordable Care Act (ACA)…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[1],"tags":[],"class_list":["post-1191971","post","type-post","status-publish","format-standard","hentry","category-news","wpcat-1-id"],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pbimBl-505l","jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/bugaluu.com\/news\/wp-json\/wp\/v2\/posts\/1191971","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bugaluu.com\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/bugaluu.com\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/bugaluu.com\/news\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/bugaluu.com\/news\/wp-json\/wp\/v2\/comments?post=1191971"}],"version-history":[{"count":0,"href":"https:\/\/bugaluu.com\/news\/wp-json\/wp\/v2\/posts\/1191971\/revisions"}],"wp:attachment":[{"href":"https:\/\/bugaluu.com\/news\/wp-json\/wp\/v2\/media?parent=1191971"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/bugaluu.com\/news\/wp-json\/wp\/v2\/categories?post=1191971"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bugaluu.com\/news\/wp-json\/wp\/v2\/tags?post=1191971"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}