Shady Practice Sees ERs, Docs Billing Patients Separately


It’s hard to decide which is worse: The fact that this problem exists, or the fact that Congress seems disinclined to fix it.

The problem, as reported on by The New York Times, is being billed after an emergency room visit by the doctor(s) who treated you because, while the visit itself was covered by your major medical insurance, the service of the doctor(s) was not. Why? Because they aren’t employed by the ER, but work there as contractors not recognized by your health care plan.

I ran into an odd variation on that theme some years ago when I went to a certain hospital in White Plains NY for an x-ray – only to be billed, a few weeks later, for the reading of the x-rays, apparently because the x-ray reader was a contractor not recognized by my health care coverage company. (This actually happened on more than one occasion.)

Arguing the absurdity of that situation, because an x-ray is useless unless it is read, I simply refused to pay the bill. ‘Never heard from them again! And rightly so.

My point to the hospital and the x-ray reader was, ‘This is between you; Don’t try to drag me into your territorial dispute or whatever it is. With those ‘others,’ I didn’t play well at all, at least not by their rules.

Health-care billing in the U.S. has become ludicrously complicated, with patients being, for the most part, totally unable to comprehend why they are being billed X for Y service. Consequently, I have developed a not-altogether-fair, very cavalier attitude to the original ‘overage’ bills I receive and all the subsequent follow-up bills from the provider organization and, eventually, one, another or a series of bill collectors: I ignore them.

I assume, at this point, one of three things to be the truth: [1] I’m an exception to the rule, and most people simply pay up – or the system could have collapsed by now (as I’ve been ignoring bills for years!); or [2] the bill collecting system truly is broken, and uncompensated hospitals and and doctors are living on borrowed time; or [3] somewhere in the collection system someone came to the realization that I was either unfairly billed – not a likely possibility, from the biller’s perspective – or mine was a bad debt that needed to be written off.

I consider [3], particular the second possibility under it, to represent the least likely scenario of those I’ve listed. The most likely scenario, I fear, is that the collections system truly is broken. But the billing system is, too, with people being charged outrageous sums for the likes of a couple of aspirins, the equivalent of a consumer level ‘Band-Aid’, or a charge for a television one was too ill to watch.

The likelihood that the latter supposition is correct is pointed to, indirectly, in the Times article, which noted that when the subject patient went to one of those billing him and asked for a reduction in the bill, it was halved! Clearly, it was unnecessarily high in the first place.

But now (not a moment too soon, I imagine you’re thinking), on to the second concern: That Congress seems to be totally disinclined to address an issue that, for complicated reasons, is best dealt with at the national level, as opposed to local ones.

Lloyd Doggett, a Democratic Congressman from Texas, last year introduced a bill that would require hospitals and doctors working in them to be ‘related,’ for billing purposes. (As you’d suspect, the legislative proposal is far more complex than that!) But as The Times put it, “he experienced a ‘healthy dose of indifference’ from his colleagues on the Ways and Means Committee” – the elite group responsible for seeing that money-related bills do, or don’t, move forward to the Congress as a whole.

Doggett plans to reintroduce the bill, but he’ll be doing so into a climate probably more, not less, likely to move the issue along – thanks to party and representative shifts created by the just-past (but hardly forgotten!) elections.

As has been noted elsewhere – a lot of elsewheres – lately, members of the American Congress are great at paying lip-service to serving the public, the people who elect them, but the members of that august body tend to vote where the money is. And on issues such as this one and most others, there are few lobbyists for John Q. Public, but a whole lot (with gobs of money) speaking out in favor of the status quo, or, at the least, again any idea that might upset it.

The patient cited in The Times article was seen by a doctor who “gave him some medication and tests, and let him go.” Shortly thereafter, the guy was billed for $1,620. And that, of course, doesn’t have anything do with what the ER billed and was paid.

The guy’s appeal to the doctor’s private practice, the group that had billed him, was successful, but only to a point:

They knocked half off the bill,” he told the paper. “Which is great. It’s like, would you rather get punched four times or two times? I guess two times is better.

But hardly better than being treated fairly in the first place!


Rubio’s Crash Course In Wreck Rescue


Photo: WTRF News

Florida Senator Marco Rubio and his Republican colleague, Nevada Rep. Joe Heck, upon witnessing an auto accident on Interstate 70 in West Virginia last Thursday evening, stopped and lent aid, pulling one victim free and providing assistance to first responders. Unfortunately, the saved man’s companion, 62-year-old Bernard Howard Bachman, died. He was pronounced dead at the scene by Rep. Heck, who is a trained combat surgeon.

The two elected officials were returning to a West Virginia hotel from an event in Ohio when a west-bound tractor-trailer apparently hydroplaned on the wet road, causing the driver to lose control. His truck crossed the median and struck three east-bound cars, all of them just in front of the congressmen.

Sen. Rubio issued the following statement, which appears on his web site:  “Jeanette and I send our prayers and condolences to the family of the individual who tragically lost their life in Thursday night’s accident in West Virginia.  I want to thank all of the first responders who arrived quickly and did their jobs with swift professionalism. Please join me in praying for all those affected.”

Rep. Heck echoed Sen. Rubio’s sentiment in a statement of his own, in which he also noted that he and his wife, Lisa, have “great respect for the first responders who handle such cases every day.”

Paint Odors? Yes They Vary By Type, Color. Who Knew?


Sometimes we learn things in the oddest ways: I was reading an article a few minutes ago on Donald Trump’s latest ‘great build’ – a supposed-to-be-luxurious hotel (and the city’s most expensive) in Washington D.C. – and I was stopped by this statement: “…As press was ushered into the renovated building—passing the unironically titled “PRESIDENTIAL BALLROOM”—the smell of white paint was still thick…”

Wait, I thought: Is the smell of white paint unlike the smell of other paints? Google (bless its probing little algorithm) quickly put my wondering mind to rest: Yes, there are differences in how different paints smell; And some are so different, and unhealthy for the environment, that federal restrictions have been placed on their creation and use.

I was floored by this information in part because I can’t recall having painted a room (or much of anything) for well over 20 years. And not being a particularly ‘handy’ type, where home improvements are concerned, while I don’t go out of my way to avoid information on that topic, I don’t often stumble upon occasions – such as the article on Trump’s soon-to-grandly-opened Washington hotel – when brush- or hammer-related articles cross my path. (I don’t even own a saw, though I would, I dare say, know one if I saw it!)

Still, I was glad to learn that the U.S. federal government has identified and set out to control paints that, while doing a brightening job, are dulling the potential of our environment to continue functioning as we need it to.

We know there’s waste in Medicare; Here’s one example: The annual ‘Medicare And You’ book consumes 1960 tons of paper!

medicare-logoTwice, between December 20 and December 30, I received automated  calls encouraging me to review my options for medical coverage – options that would take me off ‘original Medicare’ and pass control of my healthcare to a Medicare Advantage or Medicare Supplement provider. An insurance company.

This might not have been quite so annoying – though I hate automated/robo calls – if it weren’t for the fact that the annual ‘open enrollment period’ for switching from one to another option to original  Medicare ended on December 7.

There are three issues here: [1] Why are automated calls to potential clients allowed? [2] Why am I getting calls at a time, as one well over 65, and primarily limited to switching from one plan to another during the October 15-December 7 open enrollment period, I am only eligible to switch plans under certain, very specific conditions; and [3] Why are Medicare-eligible individuals limited to when they can switch from one alternative to ‘original Medicare’ to another?

Aside from those questions, there is a far greater, more-far-reaching one: Why on earth are Medicare and its alternative so outrageously complicated?

I was a licensed insurance agent for perhaps ten years. I allowed my license to expire a year ago. One of the reasons I did so was because I am not and never have been a good test-taker. And every year, agents wishing to sell alternatives to original Medicare must devote two, three or more full work days to studying the year-to-year changes in Medicare’s rules and those of plans you wish to sell.

I don’t have, and I suspect it would be impossible to learn, how many millions of taxpayer dollars are wasted annually on Medicare (and alternative) program changes that seldom if ever benefit consumers.

Sadly, there is a simple answer why Medicare employees, representatives at several levels in insurance companies, and insurance agents are put through this dog-and-pony show: Insurance companies seek the complications, because in many cases they make it easy to deny claims, because a claimant hasn’t followed every esoteric rule of the year.

Insurance companies spend huge amounts of money every year lobbying Congress for Medicare rule changes for the simple reason that they want premium-collecting to be as easy as possible and payout – claims – rules to be so complicated, so nearly unfathomable, that many people simply don’t try fighting ‘the system.’ It, the system, is totally rigged against them.

Insurance companies spend many hundreds of thousands of dollars annually rewarding agents with trips to exotic locations – trips that, truth be told, should be reported by agents as unearned income. (Chances are, though, that the insurance companies’ lobbyists have manipulated the tax laws to render such reporting  unnecessary.)

Those trips are fully subsidized by insurers’ premiums.

The open enrollment period scam – and it is a scam: there is absolutely no logical reason for its existence – is not only totally illogical, it is enormously costly to the federal government, which insists that anyone wanting to switch from one Medicare Supplement or Medicare Advantage plan to another must do so within the period that last year ran from Oct. 24 through Dec. 7.

In 2012, there were a total of 49.6 million Medicare recipients, according to the Kaiser Family Foundation. In 2013, the number of total beneficiaries was up to 52.3 million, according to the National Committee to Preserve Social Security and Medicare.

For an extremely conservative estimate, let’s assume that only one percent of Medicare recipients, in either of those two years, chose to switch from one plan to another. Some would, of course, make the switch early in the open enrollment period. Others, though, would dawdle, and not switch until the last minute. However the switching happened, Medicare, in the person of the Centers for Medicare and Medicare Services, would have had to check all the figures on all the forms and get all the changes put into place by the start of the new benefit year – January 1.

From October 30 to December 31 last year, including the day after Thanksgiving, there were a total of 42 business/working days to process, in 2012, 496,000 applications, and 523,000 in 2013. How many extra staffers had to be brought on board to process, in 2012, some 11,810 applications on each of those working days?

The insurance companies selling those policies had precisely the same problem – processing an enormous  number of apps in an unreasonably short period of time.

And the point of forcing that rush-pace effort (a sure way to ensure mistakes) is . . . what?

Could the ‘logic’ behind this system be as simple as, this is a good way to incentivize licensed agents to bust their butts, for a few weeks, with a carrot-and-stick suggestion that, by so doing, they will sell lots of policies, and make lots of commission money?

Agents who put themselves through that had better make good money (thought many don’t) during those weeks, because before the start of the open enrollment period, each of them had had to dedicate the better part of an unpaid work week to studying the changes and having their knowledge tested, before they could be ‘appointed’ to deal, in that particular year, with Medicare-related ‘products’. (‘Next, the entire studying/testing routine is done again.)

The saddest thing is, only a relatively small number of changes to Medicare regulations or to individual plans serve to benefit, in any significant way, Medicare recipients.

Someone – some group of someones, in the form of a Congressional Committee – needs to take a hard look at the shear waste the open enrollment period.

And the mind-boggling complexity of Medicare rules and regulations: This is a public program designed to serve primarily people 65 and older – an age where one’s faculties begin to fail, when one’s ability to make sense of complex language and terminology decreases dramatically, by the week or month, for many people.

Every Medicare recipient receives a new version every year of the book ‘Medicare And You’. The 2016 version weighs just shy of 12 ounces. (Each Medicare Advantage program produces a nearly-as-thick book every year for its new and ongoing clients.)

Imagine the labor that goes into producing a book whose 12 ounces actually consumes, across the 52.3 million distributed copies, more than 1960 tons of paper, ever year!

And only a miniscule share of those receiving ‘Medicare And You’ make much (if any) effort to make sense of what’s telling them!

Nineteen hundred and sixty tons of paper may not sound like a lot, but think of the tens of thousands of work hours – and taxpayer dollars – that go into producing something too complex for all but a very few  to spend, literally waste, time on.

Then there the tens (hundreds?) of millions of dollar being wasted by insurance company lobbyists and staffers – not to mention Congressional staff time – to generate a work that is, largely, useless.

These are hugely complicated programs that, if ‘fixed’ in ways suggested here, would undoubtedly have an economic impact on budget costs (positively), lobbyists (negatively) and insurance companies (ultimately, positively).

But as seems to be the case in a number of other areas – defense costs being a prime example – lobbyists have such a tight grip on the system it’s unlikely to change.



Finally the ‘Republican Rebels’ Allowed Something Good To Happen In Congress

US-CapitolWith next to no time to spare, Congress this week advanced legislation intended to give the rail transport industry three, and maybe as many as five, much-needed years to complete work on a program intended to make trains safer and reduce accidents. Without this extension, there was a serious risk that most U.S. railroads would have come to a grinding halt  year’s end – by or before midnight on December 31, to be precise.

A New York Times Op-Ed piece on Wednesday, jointly submitted by the chairman and chief executive of Dow Chemical Company and the executive chairman of BNSF Railway, described the problem in some detail. The crux of the problem, which could have halted delivery of “most of our food” to wholesalers’ and retailers’ warehouses, “the chlorine that makes the drinking water of 98% of all Americans safe to drink,” and – among other things – a very significant share of all manufactured goods, is that back in 2008 Congress set a too-tight deadline for most railroads to install “positive train control” (P.T.C.) equipment. The Times article noted that as well as insufficient-time complaints by railroads, even the Government Accountability Office acknowledged recently that progress on installation of the new safety equipment has lagged so far behind that, without the Congressional extension, the economy could have taken a $30 billion hit in January alone.

Indirectly, we owe passage of this extension – and of a comprehensive budget bill that avoids assorted other serious impacts on the running of the country and on the economy – to the Republican rebels who have voted against virtually every common-sense legislative proposal that’s come before them over the past couple of years.

Had they not been so successful at disrupting the nation’s governing affairs, now-former House Speaker John Boehner wouldn’t have been forced by them to resign. Had he remained  speaker, he wouldn’t have felt as compelled to ‘clean out the barn’, as he put it, of legislative leftovers before his departure, which took place Thursday. (He was replaced by Rep. Paul Ryan of Wisconsin, he only agreed to stand for the position if he received the backing of the several warring factors within the Republican party.)

Questions remain, though, if even three years will be enough time – given both the cost and the effort required – to get all needed P.T.C. equipment in place.

Essentially, what done by that equipment, said by the Times piece to represent “the most significant technological innovation in railroading since the diesel engine replaced the steam engine,” is to integrate and process “extremely precise data from tracks” and the engine in a way that “allows advanced hardware to [quickly and safely] stop a 100-car freight train that is [more than] one mile long, weighs 6,000 tons and travels at 55 miles an hour – in any given location and weather.”

Already, an Association of American Railroads spokesman told The Washington Post, the rail industry has spent “nearly $6 billion” to getting the P.T.C. equipment in place. And though “much progress” has been made, according that spokesman, there’s still a lot that needs to be done.