Showing posts with label Insurance coverage for anesthesia. Show all posts
Showing posts with label Insurance coverage for anesthesia. Show all posts

Thursday, March 12, 2015

New York Tells Insurance Company To Pay For Anesthesia Services For Colonoscopies

The New York Attorney General's Office has ordered an insurance company to pay for anesthesia services rendered during colonoscopies. The State AG Eric T. Schneiderman penalized Emblem Health $25,000 for billing a patient for anesthesia after his screening colonoscopy. According to the Affordable Care Act, aka Obamacare, screening colonoscopies are part of the free health maintenance procedures that are mandated by the law.

The insurance company ran afoul of the law when a patient was billed $1,320 by an anesthesiologist who was not part of his insurance network. The company paid $924 but told the patient to pay the balance. That's when the patient lawyered up and called the AG's office. According to the Attorney General, anesthesia is a necessity when a patient undergoes colonoscopy. Therefore, as required by the ACA, the patient does not have to pay any deductibles, copays, or coinsurance.

What can we take away from this? One, that anesthesiologists should get down on their knees and thank their deity of choice for the ACA. Now, when patients who have these government insurance plans come in for colonoscopies, their anesthesia bills can't be denied as so many private insurance companies try to do.

What is more amazing to me though is the obscene amount of money the anesthesiologist is billing. A colonoscopy typically takes no more than ten to fifteen minutes. In the hands of an efficient or unscrupulous gastroenterologist, seven or eight colonoscopies can be knocked out in an hour. If this anesthesiologist is able to collect that much money on each one, it's easy to see why some anesthesiologists truly have the best paying job in America.

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?