Blogfinger

By Paul Goldfinger, MD  (Editor @Blogfinger)

The New York Times ran an article this week (see link below) about the high cost of having a baby in our society. Besides the unconscionable price tags for various obstetrical  services, many insurance plans do not cover maternity care. It can cost a young couple over $40,000 to have a baby. The issue is discussed along with comparisons with other countries. It serves to point out an example of how our fee-for-service system is failing us, especially if a patient has no health insurance and needs to pay out of pocket.

Cost of childbirth, costliest in the world

Another issue related to the high cost of care has to do with hospital services. Last month I went to Monmouth Medical Center for an outpatient cardiology test. At the outpatient registration desk is a sign on the wall  (see photo below.) That sign says that you could be billed separately by all sorts of doctors if you have care at that hospital. The issue discussed below becomes more of a problem if you are an inpatient, but it can be problematic for outpatient care as well.

You would think, if your hospital is participating in your insurance plan, then all the doctors who work there (e.g. pathologists, ER physicians and radiologists) would be participating as well. It is a reasonable expectation. After all, the patient does not have the opportunity to choose staff doctors who do participate in their plan.

You could get lucky regarding separate bills (so far, I have not been billed by multiple parties  for my test. I think my insurance company will pay.)  But, according to that notice above, you could  get some big surprises in the mail from all sorts of physicians who were involved in your care, such as the doctor who read your x-rays , for example.  This situation becomes especially concerning if you are hospitalized for care, and many physicians, tests, and procedures are involved.

I ran into this issue myself several years ago when I went to the ER at Jersey Shore University Medical Center. I was treated and released.  One reason I went there was because that hospital was  listed as part of my insurance company network, so I expected that ER visit to be covered.  But subsequently, I got a bill from the ER doctor. It said that he does not participate in my insurance plan, even though the hospital does.  I complained all the way up the ladder and finally I reached an administrator who told me that they have been unable to convince the ER physician group to participate. Finally they stopped billing me. You need to complain if you run into this.

As you can see from the Monmouth Medical Center notice above, the same thing is still going on. In fact, I suspect it will get worse. It can be a consumer’s nightmare, as illustrated in the NY Times article above.

I wish I could tell you if Obamacare will fix this, but I don’t know.