Real numbers not too much to ask

Late last summer, a Sandy Springs woman who felt numbness in her face and arm went to Emory Saint Joseph’s Hospital, which she knew was in her insurance network.

“I’m an educated advocate for my health care,” she later said.

Yet a month after her treatment, according to an account in Georgia Health News, she received a $700 cardiology bill. The primary cardiologist who had seen her was in her network. A second was in the same medical group as the first — but, under Georgia law, an independent contractor.

Apparently being an “educated advocate” isn’t enough. And this particular patient was indeed no stranger to the fine print of public policy: She is Vicki Willard, wife of state Rep. Wendell Willard, R-Sandy Springs.

Such “surprise billing” is so common a practice in Georgia that bills in both chambers of the General Assembly — one of them proposed by Rep. Richard Smith, R-Columbus, who chairs the House Insurance Committee — have been drafted to address the issue. (The Senate version is largely the work of Sen. Renee Unterman, R-Buford, who is a nurse by profession.)

This is obviously not just a matter of lazy or ill-informed health care consumers not paying attention. The Atlanta Journal-Constitution recounts the experience of the Keadeys, whose baby was delivered at in-network Northside Hopsital by an in-network obstetrician. Then came “surprise” bills for hundreds more dollars, from a pathologist who analyzes afterbirth, and the hospital’s on-duty pediatrician. “And I’m pretty savvy on the issue,” said Matthew Keadey — a physician.

As reported in the AJC, more than one of every five insured emergency room patients at in-network hospitals receives at least one surprise bill, according to a Yale University study.

The dispute is between health insurance companies and out-of-network doctors who say the insurers don’t pay them enough. The bottom line, as always, is the consumer’s problem.

Obviously, a compromise between the medical and insurance communities would be the best route toward alleviating this problem. But at a bare minimum, health care consumers — which is to say, all of us — deserve basic truth in pricing. The first, most obvious fix for “surprise billing” is that it shouldn’t be a surprise. The likelihood — indeed, it would seem in many cases, the inevitability — of expenses not covered by health insurance should be clearly spelled out for patients and their families.

Beth Stephens of the consumer advocacy organization Georgia Watch told GHN that medical bills were the single most common topic of calls last year. For many families this is not an inconvenience, but a true financial hardship: Federal Reserve statistics show that almost half of Americans wouldn’t be able to afford a $400 emergency room visit without selling something or borrowing money.

Political battles over affordable health care are one thing. But not to know whether your care, even if you know what it is, will be affordable or not is an inexcusable and unsustainable state of affairs.

This story was originally published February 8, 2017 at 3:41 PM with the headline "Real numbers not too much to ask."