By E’Louise Ondash, RN
I’ve been thinking about it a long time, and I just don’t see how our health care nonsystem can survive such as it is for the long run. Many have told us this already, but it’s taken me a while to catch up. The costs are absurdly exorbitant and seem to be increasing, and obtaining the right care—never mind for the right price—can be a task that even health care professionals find difficult and confusing.
I’ve had several recent experiences, or frustrating mishaps, with health care and health insurance—and I’m a nurse who has written fairly extensively about consumer medical matters. If this has been challenging for me, how difficult must it be for those who know little about medicine or how to navigate through the nonsystem?
I use the prefix “non” because there is no system.
Rules vary widely among health plans, and to the consumer, it feels like a free-for-all. Even within the same health plan, the rules are inconsistent, and can be viewed as unfair. Some would even call them unethical.
So many people are finding it so difficult that it’s increased the need for the role of nurse-navigators. These navigators are needed to assist patients in getting the care they need and deciphering the complicated rules and regulations, and of course, it’s an extra expense.
Here’s one problem that seems to be a growing trend: patients are being billed for the services of out-of-network physicians who are working for in-network hospitals. Patients who come to these hospitals for care, as dictated by their insurance plans, are discovering only when the bill comes that the doctors who saw them do not accept their insurance.
This has happened twice this past year to me and my family members, and I’ve read about others having a similar experience. For instance, the New York Times recently ran a story about a man in his mid-30s who needed cervical spine surgery and was billed $117,000 by an assistant surgeon. The patient had no knowledge of this assistant surgeon, had no contact with him, and the surgery was performed in a hospital that is covered by surgical residents, who could have assisted for free.
The patient’s insurance company actually paid the assistant surgeon the full fee, much to the chagrin of the patient. (The surgeon is being investigated for “exorbitant” charges.)
As nurses, I’m not sure what we can do to stop the escalation of health care costs beyond what any consumer would do. I do think nurses should answer honestly any questions that patients have about acquiring care or what their options are if patients have choices.
There is no debate that some of the burden of high costs rests with consumers whose lifestyles promote poor health habits that can become chronic conditions. Nurses should do everything they can to help these patients whose unhealthy lifestyles cost us all. Still, there are many who, like the patient who needed cervical surgery, have no control over their health care expenditures.
Nurses also can report any unethical or illegal actions by individuals, institutions or health insurance companies, and write local and federal legislators about escalating costs and the problems they see within the nonsystem.
Have you experienced or seen instances of over-charging or unethical charges for health care? What did you do? Tell us about it.