The price of healthcare should not be a moving target


It's time the healthcare industry stopped discriminating against patients.

Yes, you heard that right. At a time when healthcare is supposed to be more patient-centric, the patient is being left behind.

Patients are being shafted when it comes to medical billing. They may be asked to pony up more than health insurers. This has been standard practice in many states. A healthcare provider accepts a payment from a payer for the fair and reasonable value of the medical goods or services provided. Then he goes up to the underinsured patient and puts his hand out for more money. St. Louis lawyer Paul Passanante says such providers are engaging in discriminatory billing practices and price gouging.

His client, Steven Powell is suing Washington University in St. Louis, alleging the university's doctors and other healthcare providers routinely overbill patients for medical services.

"A fair and reasonable charge should be based upon the medical goods and services provided," Passanante's petition says. "It should not be a 'moving target' which is different depending upon who is responsible for payment."

Insurers will get all caught up in a tangle of allowable vs. billable charges. Remember, these are the people who brought you the curious explanation of benefits, which I've heard called--facetiously no doubt--a bill that's not a bill.

From the customer standpoint, it seems strange indeed that healthcare providers can accept a different payment for something, depending on who is footing the bill.

Passanante's petition notes that healthcare providers bill Medicare one amount for a given good or service, health insurance carriers another amount for that good or service and uninsured and underinsured patients different--and sometimes greater--amounts for the same goods and services.

No one ever tells the patient that their insurer's payment will rarely be accepted as payment in full. "The patient is not told that the charge for which they will be held responsible varies, depending on who their insurance carrier is," the petition says. "The patient is not told that the healthcare providers engage in cost-shifting, and that they are really paying not only for the service rendered to them, but subsidizing the uninsured and Medicare patients."

Passanante, is convinced he'll win the case. Healthcare providers in Missouri will have to convince a jury that the charge that is the highest of the charges, the one that they establish and set, but almost no one pays, is the "fair and reasonable value of the service. "Juries are smarter than that," he wrote.

One can only hope that's the case. - Sandra

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