Business
Surprise medical bills are a well-known problem within the U.S. healthcare system, but a few bad actors are playing an even more sinister trick on healthcare consumers and employer group plans. Scott and Ed welcome Jennifer Hill, Senior Clinical Consultant from the Lockton Dunning team, to the podcast this week to discuss this new trick of the surprise medical billing trade. This one involves self-dealing by some providers and shockingly egregious billings intended to line their pockets at the expense of the patient and the patient’s employer group medical plan. Isn’t “surprise billing” Scott’s deal with his fancy friends in D.C.? How are some healthcare providers using affiliated, out-of-network entities to gouge the system? Can an in-network surgeon charge $7,000 for a procedure but bill $372,000 for their attending surgical nurse? (Apparently yes, if they are set up as an out-of-network entity.) Who comes up with these schemes and how do they come to fruition? What can a self-insured plan sponsor do when it is asked to pay these illegitimate, astronomical charges? What has Lockton, specifically Jennifer herself, done to investigate these charges? (Unfortunately, the providers really didn’t just forget a decimal somewhere, as Jennifer initially thought.) Why does Scott cringe whenever it’s time for “Deep thoughts, from Ed?” If Congress is aware of this problem, why hasn’t it acted?