Getting In-Network Care is Harder Than You'd Think

In a recent Health Affairs article, the Commonwealth Foundation conducted their periodic survey of eleven countries to see how access issues might have improved or worsened. We've covered these data before. Let's update. This is Healthcare Triage News.


John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

And the housekeeping:

[AbbeyB]

This reminds me of a bizarre scene I saw when I was visiting a friend in San Antonio. She injured her foot, so I offered to take her to the emergency room at her network hospital. There was a lady there in the next cubicle over who was quizzing every doctor and nurse that came near her if they were in her network, and she refused care from a doctor, in an emergency room, when he said he didn't know. He pleaded with her to let him do his job because they were very busy but she wouldn't let him touch her until he confirmed he was in the network. I'm Canadian and I found this strange scene to be rather bonkers, but my friend just shrugged and said she guessed this other lady had heard about these anecdotes and was paranoid of being billed for an out of network doctor. I might have to wait many hours if I go to a hospital because I live in the Greater Toronto Area, but I've never paid a penny for a doctor's visit outside my health premium, which no one pays more than $900 a year.

[kds]

You make a good case for nationalizing all of it, lock, stock and barrel. Hospitals, labs, everything. And Doctors too.

[timsid]

Smooth, Dr.Carroll. Right up there with the "OH! Hello. I didn't see you there..."

[matrinoxtm]

It's weird that you have to pay for Emergency care. It's hard to call USA an advanced country where basic necessities are not covered. Imagine if your house burnt down and you had to pay the fire bill.

[musicfan]

It gets even more sneaky than that. Even if you look up a provider in your insurance's provider manual, you have to make sure the location the in-network provider is at is listed too or the insurance company will treat it as out-of-network. You need to ask the provider for their tax ID number at the location you want to go to and check that with your insurance in order to make sure they are being coded as in-network. I got hit with a $300 charge for a checkup that was supposed to be $0 because my PCP changed offices and their new office was not listed in my insurance's provider manual.

[ShadowDrakken]

It's really time to get rid of the ACA and go to true socialized medicine. ACA, and really just the entire insurance system as a whole, is a total disaster.

[steveh]

High deductibles and out of pocket costs are meant to drive down wasteful health care spending. But, in reality, they amount to a punishment for people who become ill, particularly if you have a chronic illness. No other country tries to control health care costs by choosing to punish people for getting sick.

[zowhy]

the cutest little quick plug at the end love it

[dogboy]

Hmm. Why are we even discussing the nuances of 'in network' and 'out of network' care? Why are medical care services so expensive in the first place? Is it possible that the ever increasing demand for medical services far exceed the scarce supply?

What are the barriers that reduce the entry of new supply of medical care? Is is possible that the medical care industry has artificially high barriers to entry, generated by both governmental agencies, in collusion with the medical guilds?

[cheryls]

I see this every day in my job with a physician billing service. Physician specialists are contracted to consult and provide services to people in hospital but they are not always in-network. Hospitals are supposed to get those services pre-authorized to cover consulting physicians but it's often overlooked. I appeal the denials and request retro-auths which are often denied. It's painful when I have to turn a physician bill to patient responsibility after they've just been through a cardiac or other necessary procedure. It's why I always choose the open option plan with employee health plans. I know I could never afford those types of bills.

[chrisf]

I went with an HMO, but only because in my Huge Metropolitan Area nearly everyone I would want is in that network, and there is some out of network coverage too. I can't imagine going for an HMO almost anywhere else in the US.

[ROFLMAOtheNARWHAL]

Shit like this is why I don't even want to bother with insurance. The tax fine is cheaper than some shitty plan that will always find some way to tell me "no" whenever I actually use it.

[The_Lone_Aesir]

and to make matters worse the bill you get is likely to be on "final notice due immediately" even though it's the first notice. when they send it for collections you don't get Just one collection on your credit. instead you get multiple collections with each pertaining to a different group within that hospital.

[krellend]

Cost-sharing was also shown to drive down NEEDED medical care as well as unneeded. Is it really doing what we mean it to? Does it actually help?

[monkeyonfire]

Where do I go for information about health codes and laws? How do I know when I'm getting taken advantage of? Is I normal for a doctor to show your medical transcripts to another patient who said they know me? Is it normal for a doctor to imply that I might develop a drug habit in ten years if I continue to take a medication and let me suffer every day as a result? Lots of questions I know.

[lovelyhera]

My company just switched to new insurance- thankfully my medical group, and my specific physician are in-network for my new insurance. Phew.

[DorthLous]

I liked the video, but man, you need to work on that transition. That was very tone deaf.

[ANTIMONcom]

wow, healthcare in the US are so bad. Makes this series more entertaining though, so we can all call worth!