"Who protects patients when things go wrong on healthcare’s financial side?" Lieberman asks. "What happens when you receive a bill you didn’t expect and can’t afford to pay? What happens when insurers send unintelligible explanations of benefits you can’t understand? What about questionable loan arrangements to avoid medical bankruptcy?"
She answers, "Consumers of health care are pretty much on their own. From the 1960s though the 1980s when people complained, they got action from consumer organizations, government and even businesses that set up departments to handle complaints. That consumer movement is now but a flicker."
One problem is Medicare's three-day observation rule, which left John Rutledge of Wheaton, Ill., with $15,000 in hospital bills after his wife was admitted for observation, despite the fact that he refused to sign a document concurring to that statement, Lieberman writes. "Thousands of families have been caught when hospitals decide their loved ones are admitted for 'observation,' a tactic that allows them to avoid repaying Medicare if government auditors find patients should not have been classified as 'in-patients.' Playing the 'observational' game is worth millions to hospitals but costs families tens of thousands of dollars when someone doesn’t qualify for Medicare-covered skilled nursing care."
Another problem is ambulance charges, Lieberman writes. "Kathryn Green, a college history professor who lives in Greenwood, Miss. is fighting an air-ambulance company, which transported her late husband to a Jackson hospital after he suffered a fatal fall in their home. This 'nightmare,' as she calls it, is a bill from the transport company that claims it’s outside her insurance network, and says she owes them $50,950. Green is raising a ruckus and has taken her case to state and national media, members of Congress, the state attorney general, and the Mississippi Health Advocacy Program. The company has told her it will begin collection efforts."
"In both cases there’s a legislative solution," Lieberman writes. "The three-day rule can be fixed by counting all the time a patient spends in the hospital whether they’re classified as an 'in' or as an 'observational' patient. The ambulance problem can be fixed by changing the 1978 airline deregulation law that prevents states from interfering with fares, services, and routes. But money and politics block the federal changes that would help people like Rutledge and Green."
Lieberman invites consumers who have had billing issues to contact her at email@example.com. Her column often appears on Kentucky Health News, published by the Institute for Rural Journalism and Community Issues, which publishes The Rural Blog.