Who pays?
Recently, Anthem BCBS rescinded its policy of limiting the amount of anesthesia it would pay for during operations. The policy conjured images of patients waking up before the end of their operations, or later being confronted with unexpected bills. But allegedly, that’s not the intent:
“Anesthesia services are billed partially on the basis of how long a procedure takes. This creates an incentive for anesthesiologists to err on the side of exaggerating how long their services were required during an operation. And there is evidence that some anesthesiologists may engage in overbilling by overstating the length of a procedure, or the degree of risk a patient faces in undergoing anesthesia.
“Starting in February, Anthem had planned to discourage overbilling by adopting a set of maximum time limits for procedures, inspired by data from the Centers for Medicare and Medicaid Services. If an operation went long for medically necessary reasons, anesthesiologists could appeal for higher payment. But the process of reimbursement would be more arduous.
“Critically, contrary to Sen. Murphy’s claims, this policy would not have saddled patients with surprise bills, if their operations went over time. The burden of this cost control would have fallen on participating anesthesiologists, not patients, according to Christopher Garmon, associate professor of health administration at the University of Missouri-Kansas City’s Henry W. Bloch School of Management.”
I dunno. This sounds a little like the Trump tariff argument. Trump believes that importing countries pay the tariffs. Others claim that the importing companies pay. The reality is that importers pass the cost on to consumers, so consumers pay for tariffs. While anesthesiologists will be incented to stop overstating the length of procedures, they’ll just bill more per minute. Unless there’s something I’m missing here, I don’t see how this fixes the problem of overbilling, it just moves it to a different category.
The real problem is that we have a for-profit healthcare system that valorizes money over patient care, costing twice as much as other industrialized nations for the same or worse care. We need some form of single payer, like the other industrialized nations on the planet. A subsidiary note is that many or most American-trained doctors begin practice with hundreds of thousands of dollars in student loans to pay off, incentivizing them to go into the most lucrative specialties, rather than primary care.
Who pays the anesthesia bill?
“Anesthesia services are billed partially on the basis of how long a procedure takes. This creates an incentive for anesthesiologists to err on the side of exaggerating how long their services were required during an operation. And there is evidence that some anesthesiologists may engage in overbilling by overstating the length of a procedure, or the degree of risk a patient faces in undergoing anesthesia.
“Starting in February, Anthem had planned to discourage overbilling by adopting a set of maximum time limits for procedures, inspired by data from the Centers for Medicare and Medicaid Services. If an operation went long for medically necessary reasons, anesthesiologists could appeal for higher payment. But the process of reimbursement would be more arduous.
“Critically, contrary to Sen. Murphy’s claims, this policy would not have saddled patients with surprise bills, if their operations went over time. The burden of this cost control would have fallen on participating anesthesiologists, not patients, according to Christopher Garmon, associate professor of health administration at the University of Missouri-Kansas City’s Henry W. Bloch School of Management.”
I dunno. This sounds a little like the Trump tariff argument. Trump believes that importing countries pay the tariffs. Others claim that the importing companies pay. The reality is that importers pass the cost on to consumers, so consumers pay for tariffs. While anesthesiologists will be incented to stop overstating the length of procedures, they’ll just bill more per minute. Unless there’s something I’m missing here, I don’t see how this fixes the problem of overbilling, it just moves it to a different category.
The real problem is that we have a for-profit healthcare system that valorizes money over patient care, costing twice as much as other industrialized nations for the same or worse care. We need some form of single payer, like the other industrialized nations on the planet. A subsidiary note is that many or most American-trained doctors begin practice with hundreds of thousands of dollars in student loans to pay off, incentivizing them to go into the most lucrative specialties, rather than primary care.
Who pays the anesthesia bill?
Joel:
It seems to me, there would be standards for how long an operation should take and mitigating circumstances which would require some type of explanation. For example, if more time is needed, than what is the reasoning?
I have not found anesthesiologists to be the easy people to converse with if needed. They are demanding of their fees independently (my experience) of hospitals. No credit card to be used. I can not remember if mine would accept a check. If was not a few hundred dollars either. An aspect I have found with medical professionals (some), they tend to talk down to you. I tend to ignore it till I have a foundation to ask questions. They seem to be independent of other doctors.
There appears to be a shortage of them which has occurred since the pandemic. One article:
The anesthesia workforce: Supply demand imbalance part one
@Bill,
The insurance decision can be appealed. Don’t know what the success rate is.
My impression is that certain medical specialties (anesthesiology, pathology, radiology) tend to attract people who don’t have a good bedside manner.