Monday, October 26, 2009

Insurance coverage for anesthesia

Here is an interesting comment (#25) on the Prescriptions blog of the New York Times. I copied it in its entirety.

Rein in the anti-competitive practices of the anesthesiologists

One of the overlooked issues in the entire health care debate has been the fact that most anesthesiologists who work at hospitals choose not to “participate” in the health insurance programs that the hospital accepts. So, wise consumers can choose a “participating” hospital and also select a surgeon who “accepts:” their insurance but find that they will have to pay the anesthesiologist whatever is charged. And, they cannot elect to bring in an independent anesthesiologist. All who work at a hospital either are in one large group practice or choose to accept the same insurance programs.

Therefore, the only insurance coverage for the anesthesiologist will be “out of network” coverage. This requires a “first dollar” expense each year and then only reimburses about 70% or “usual and customary” charges — regardless of the actual bill. This means that an operation that, is in-network for the hospital and the surgeon, might result in a bill from the anesthesiologist for over $5,000. Of this amount the patient might have to pay $3,000 or more.

The simple solution, in the sprit of cost containment, full price disclosure and anti-monopoly practices, is to require all medical procedures done in the hospital, by any personal, be covered by the same set of insurances. So, if a patient inquires of a hospital, “Do you accept the XYZ medial plan?” an affirmative answer will mean that all doctors, nurses, lab technicians, and anesthesiologists will be covered by the same reply. People and firms who do not agree to accept the fees of that plan will not be allowed to work at the hospital. They can choose to work elsewhere.

The reason this is critical, is that once admitted to the hospital, a patient does not get to choose which anesthesiologist will participate in the procedure. One meets the anesthesiologist minutes before being rendered unconscious. The anesthesiologists who practice at the hospital have a monopoly on all the anesthesiology business and should be regulated and required to “accept” the insurance programs that the hospital itself accepts. If they do not like the requirement rates of the insurance programs accepted by the hospitals where they work, they can seek changes or they can choose to work elsewhere.— steven epstein

While this rant sounds like it came from a disgruntled surgeon, it could just as easily have come from a patient suddenly faced with a large anesthesia bill they were not expecting. I've had patients ask me whether I accepted their insurance. If it's Medicare, that's a no brainer. But unless I call my business office, I really couldn't tell you which insurance companies, other than one or two offhand, that our group accepts. I've never had a patient write me a nasty letter afterwards saying they felt deceived by our insurance acceptance so I presume they were fine with our insurance coverage.

What has been the experience of anesthesiologists out there in regards to this issue? Are we being needlessly criticized for not accepting the same insurance policies as the surgeons? Would we then be beholden to the surgeons and the hospital to accept some insurance contracts but not others thus limiting our ability to negotiate a fair rate of reimbursement?

4 comments:

  1. Had hoped there'd be a comment or two. As a resident I clearly don't have any idea, but it's an interesting topic of which I'll need to discover/ research at some point before finishing in 2 years.

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  2. I read your article and just had to comment on it. My wife and I just had our first baby in January of this year. We selected our Hospital based on the fact it was very close to where we live and that they took our insurance. 60 Days before my wife was admitted, the hospital required that we submitted all required paperwork and insurance information. They had our insurance information 2 months before my child’s birth and NEVER said anything about the selection of the anesthesiologist. Why didn’t they inform me that they only used a specific group of anesthesiologists? Better yet, why didn’t they inform us that this group of doctors was not in our network? Is it possible that the hospital is receiving kickbacks from these doctors? Is that even legal? It seems to me that would have to be a conflict of interest. What if any legal position do we have in this matter?

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  3. Mr. Epstein frames the issue very clearly. The system needs changing. Under the current system consumers have essentially no choice. Few other businesses are allowed such monopolistic control.

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  4. Anesthesiologist just extort money from the patients by not participating in insurance. Leave the patients to pay thousand of dollars.. No one want to have surgery for fun! its just sick!

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