Surprise billing and COVID: The Ultimate Podcast
Before continuing with this posting, we would like to acknowledge the heroic efforts of frontline healthcare workers, risking their own health and even lives to save others. These are not the people sending the bills. That would be the private equity-controlled hospitals and specialty groups. it is important to draw a bright line between these cohorts.
You might have read somewhere that surprise bills are not allowed by hospitals taking funds under the CARES Act. This is true. The patient share is limited to what they would have paid in-network.
So who do you think is paying that bill? Look at the person six feet to your left. Now look at that person six feet to your right. All three of you are.
This bill isn’t a price control for out of network providers. The bills don’t automatically get lower. Only the patients are protected. This actually makes surprise-billing much easier, because the employee is not likely to complain if it’s not their bill. Who even reads the EOB? How many employees even know wht EOB stands for?
Recently DirectPath released a report called the Health Care Literacy Gap. In it, they noted that 55% of employees already don’t complain about billing errors, because they don’t feel it’s worth the effort.
Why don’t they feel it’s worth the effort? Let’s put it this way: when was the last time you didn’t complain about a billing mistake at a restaurant, hotel, etc. ?(Yes, we know it was more than a month ago. We are being figurative here.) That’s because it’s your money.
But if the waiter or hotel manager came over and, instead of presenting a bill, said the whole thing was on the house? Would you ask to review the bill and point out mistakes? And that’s exactly what could happen if patients are held harmless from out-of-network charges due to COVID.
COVID treatment should be free in any case. But if you read the CARES Act closely, it appears that even patients testing negative who are then treated for something else may be immune from surprise bills. Once again, who do you think is paying?
And you can bet there will be more of them than ever in 2020. That’s because the private equity companies are counting on the facts not just that employees won’t complain, but that your overall healthcare spend will be way down…and as a result you won’t carefully review your individual charges.
This of course doesn’t include the surprise bills employees will get as a result of other emergency visits, admissions, and deliveries. Heart attacks aren’t going away.
Fortunately, there is a solution. You can implement it posthaste. It’s all wrapped up in this podcast. The podcast features not only me, but uberbroker David Contorno, ERISA guru Doug Aldeen, and Rachel Miner, who in addition to being a successful broker, actually had the unfortunate chance to have to use our surprise bill “hack” in a North Carolina emergency room. North Carolina provider are notorious for their high-multiple-of-Medicare pricing, but this hack you’ll be hearing about kept her bill to a paltry 2x Medicare, including for any out-of-network “ologists” consulting on her son’s case.
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Corona-meets-surprise bills: six things you don’t wanna know
Thanks to corona, surprise bills are ba-ack. And as you read below, you’ll see why coronabills will be a thing in 2020.
You can listen to a new podcast on this exact topic when you go to work. That is, assuming, you either work in an essential industry that you need to actually go to, such as supermarkets, first-responding or healthcare (and thank you for that!!!), or you work at a place where you can easily socially distance, such as repairing Maytags, arguably the safest job on earth.
The private equity firms that own these out-of-network practices are no doubt relieved that surprise bills have magically disappeared from the headlines — but they have not magically disappeared from your claims spend. PE firms have not suddenly decided en masse to become good citizens. Quite the opposite – their other investments are foundering, with out-of-network providers being the bright spots in their portfolio. All thanks to surprise billing.
Here are three of the Six Things You Need to Know about Coronabills.
1. There is zero chance of federal surprise billing legislation this year
Consider the rather sketchy ad campaign run in “swing districts” last year by the private equity firms owning these practices. The theme was that if doctors don’t get paid enough, there won’t be enough doctors.
Well, as effective as that campaign apparently was in 2019 (you didn’t see any surprise bill prohibition passed into law, right?), imagine how effective it would be in 2020. All they would need is a few live shots of overwhelmed emergency rooms, which aren’t exactly hard to come by.
Prediction: it’s not just that nothing will pass. You won’t even see a bill make it out of Committee this year.
2. Because your total health spending will drop precipitously in 2020, you won’t carefully parse your bills
Executives pay more attention to healthcare spending – or any budget item – when it is rising. Elective procedures and doctor visits are so far off this year that total spend will decline. Hence you probably won’t even notice these surprise bills.
3. The canary in the coal mine would be employee complaints about surprise bills. Except that the copay is zero in many cases
As an ERISA plan, you don’t have to offer full coverage for treatment. But most of you will follow your carrier’s guidance. Which is to say, you will offer full coverage. Hence employees won’t be balance-billed. And that in turn means they won’t notice the total bill. Or, if they do notice, they won’t care. Bottom line: these bills won’t come to your attention.
Interested in more? Listen to the podcast or click through to Quizzify’s blog post on coronabills.
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You need to slash benefits spending. Drexi is a start.
In employee health services, almost everyone with internet access is giving out awards for something-or-other. Wellsteps, for example, gave out 25 of them at once, including several to companies that no longer exist, along with an award to itself. Therefore, it can safely be assumed that a beam of light leaving Wellsteps wouldn’t reach due diligence for several seconds.
Not so with Valid Vendor of the Month Award, given out by our alter-egos at Quizzify. These awards are real. How can you be sure? Not just that each of the Valid Vendors are validated by the Validation Institute, though that’s a great head start.
More specifically, Quizzify is so confident of its Valid Vendor selections that they are placing 33% of their own fees at risk for the performance for each Valid Vendor of the Month. While many vendors won’t even put a third of their own fees at risk for their own performance, Quizzify is putting a third of its own fees at risk for another vendor’s performance. The ground rules –and all disclosures—are at https://www.quizzify.com/valid-vendor-awards
Below is Al Lewis’s story, reprinted from Quizzify.
I recently met Bill Miller, who runs Drexi. Drexi is a tech company disrupting the pharmacy space with next-generation PBM services compelling enough to win the 2020 Health Value Award from the Validation Institute, as was announced this week (3/30). They also have direct-to-consumer memberships that offer discounts on brand and generics at participating chains, bypassing the standard PBM markup that they charge for “managing” your purchase of a few pills.
Bill told me this. “Sounds great,” I replied, “But it wouldn’t work with me.”
“Why not?” he asked.
“Because I was paying $136 out of pocket for 90 5-milligram zolpidems (Ambiens) at CVS. I tried Optum’s mail order. Same exact price. Then I heard I could purchase them through the dispensary at my PCP’s practice and pay only $18.40.”
In case there is someone reading this who has never been snookered by a PBM “negotiating” for you, here’s what a receipt looks like, for a covered benefit for a generic medication:
Now let’s compare my CVS receipt for $136 — the price that my PBM had thoughtfully and painstakingly procured on my behalf with CVS, no doubt after several tense negotiating sessions in a smoke-filled room – to the receipt from the dispensary at my nonprofit physician practice.
I bought these zolpidems for a mere $18.40, knocking fully 86% — 86% — off the CVS price. No way Drexi can beat that, I thought.
“Well, let me at least try,” Bill offered.
“Fine,” I replied, using the tone of voice I normally reserve for a wellness vendor buttonholing me at a conference to explain that while every other wellness vendor lies and loses money, they really do get behavior change and dramatically reduced costs.
Bill searched on Drexi for “90 5-milligram zolpidem”.
“Is there a Walgreen’s near you?” he asked.
Indeed there is. Turns out that, had I used a Drexi card, I could have gone right across the street from the CVS to the Walgreens and paid $10.40, which I made a note to do in April. This would be a 43% reduction off my 86% reduction. What a savings! What a story!
But wait…there’s more. Now how little would you pay?
That wasn’t remotely the end of the story, as it turns out…I’m pretty close to a Wegman’s, where it turns out I could have gotten those very same 90 pills for: $3.60. This would be a 67% discount off my 43% discount off my 86% discount. Here is the Drexi screenshot.
Yes, way cheaper even than Walgreens. But I live fairly close to a Walgreens, and it’s a much more pleasant bike ride, so I figured I would just go there. I was already way ahead of the game with the $10.60, and it was a nice day for a ride. (Just in case anyone is keeping score at home, I didn’t do anything irresponsible. This trip took place on a date early enough in March that I still could reasonably expect my 401k to support my retirement.)
And the envelope please…
Between the time Bill Miller showed me the Walgreens price and the date of my visit, Drexi had negotiated an even better deal with Walgreens: I paid – get ready — $3.25.
Was this a perfect experience? In the broad sense in which that word often gets used these days, yes. On the downside, the pharmacy tech did spend a little bit longer processing my card than typically with my regular insurance. (That may be because I was a first-time user.)
Note: there is an admin fee. The retail-user fee (that I pay) is $7/month for unlimited prescriptions. Since I am saving about $15/month off my already deep-discounted price from my PCP practice, the extra $7 is a no-brainer for me. Plus, Walgreen’s is closer, stays open later, and usually runs a 2-for-1 sale on my go-to OTC remedy, Refresh Plus lubricant eye drops.
And that’s why Drexi is the April Quizzify Valid Vendor of the Month.
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The latest coronafad: Chloroquine
It’s human nature to look for a cure or treatment for a serious disease. People tried to ward off the plague with garlic. Those with long memories might recall Laetrile, for example. Laetrile was relatively harmless – at least in comparison to chloroquine or hydroxychloroquine, which self-medicating people have already died from. That stuff, newly approved to treat COVID-19 by the FDA, is figuratively flying off the shelves — in what appears to be nothing more than the latest coronafad. (If that is not a word, it should be.)
It is featured in our current quiz, which also introduces our first picture questions. Meanwhile, here are Six Things you and employees should know about this latest coronafad.
(1) All the studies are small
And all the analysis is rushed. But studying the impact of an intervention on an acute condition doesn’t take years, the way a diabetes prevention study might.
There is also a rule of thumb in these situations that if an impact is big, it should show up in a small sample. The best example of that how few patients were needed to conclude that smoking caused lung cancer or that severe hypertension caused strokes. (In both cases, those weren’t even acute events. Yet the results were known relatively quickly because they were so clear.)
(2) The French study, which launched this, was not controlled
Yes, hydroxychloroquine was given to a small group of patients, and yes, they improved. But the results were largely anecdotal. In normal times, no respected journal would even let it get to peer review. But these aren’t normal times. Nonetheless, there is something called a “meta-analysis,” where multiple results showing minor changes can be combined into one ersatz study that would be statistically significant.
(3) The most recent study, from China, was also small and shows no impact
Unfortunately, the reverse was true here. The “confirming” study showed the opposite.
Of the 15 patients who got treated, 13 tested negative (you probably know this already, but “negative” is good, as this brief video demonstrates) after a week of treatment. That sounds promising — except that of the 15 patients in the “usual care” control group, 14 also tested negative. This is why control groups are considered the “gold standard.” Most of us over 60 had our tonsils out as kids, to make earaches go away…but it turns out earaches would have gone away anyway. There was no control, merely pre-post.
That sample of 30 is too small to say that the drug does not work. However, it can clearly be stated that it doesn’t work well in an undifferentiated population hospitalized with pneumonia. It can’t be ruled out that it has a positive impact if administered at an early stage, or on some cohort (younger people or women might be examples of discrete cohorts).
However, people with mild cases need to consider the side effects…
(4) …There were side effects in that study
The more serious the condition, the more side effects are tolerable. So chemotherapy and HIV drugs have substantial side effects…and yet get approved by the FDA because the alternative may be death.
Hence, an approved (though not for this use!), powerful drug that somehow treats both malaria (caused by a parasite) and allegedly coronavirus (caused, of course, by a virus) could be expected to have some side effects…and indeed it appeared to, in the study group.
Once again, though, some patients in the control group got complications too. Because the patients were so ill, attribution to the drug itself would have been difficult even in a larger sample.
(5) These side effects in general are serious and substantial
For malaria, this drug was researched multiple times, because during World War II so many troops in the South Pacific were getting it.. While showing some promise as a treatment, the side effects were unbearable for many subjects, even prisoners who were promised early release if they followed through.
The dose that triggered these toxicity effects was a small fraction of the dose in the French study, though the specific French formulation should be safer in similar dosages.
(6) This looks like a massive case of confirmation bias
Probably within weeks, this drug will go the way of zinc, elderberry concentrate, essential oils and other immune “boosters” as just another coronafad. It may find some niche in treatment of certain small segments in which the benefits (if any) exceed the possibility of harm, but for the rest of us the reverse will certainly be true.
If you want to indulge in a harmless or even potentially beneficial albeit useless coronafad, try the sips of water every 15 minutes. This allegedly washes down the virus, the way you might drink milk to wash down a cookie. (This isn’t the way viruses work, but that’s a blog for another time.)
The wellness industry has been encouraging us to do this for years. Water, water, everywhere. The only possible risk is tripping and falling on your way to the bathroom.
Sign up here to join our mailing list and to receive the new Coronaquiz IV: Busting the Myths and Gobsmacking the Fads…featuring (you guessed it) chloroquine.
And visit https://www.quizzify.com/coronavirus to play all four coronaquizzes to identify knowledge gaps and obtain accurate, up-to-date information.
They Said What? 