Increasingly, insurance companies are selling health policies that are pure vaporware in terms of their claims of “out of network” coverage, when preferred or needed by beneficiaries. So, when patients choose an out-of network doctor or hospital, the actual coverage is paid at a small fraction of the actual cost. Patients are stuck with the difference, and physicians are often stuck with non-payment. The reality is that these policies are misrepresentations of actual coverage, and recently physician and patient advocates in New York (and other states) and the AMA have successfully filed suit against blatant abuses. Catherine Hanson, JD, a fantastic AMA health attorney, has been all over these issues on behalf of doctors and patients.

FairHealth is a two-year old organization formed out of a settlement in New York that AMA and MSSNY (Medical Society of the State of New York) and others against these kinds of abuses. Former ASMA President Nancy Nielson, MD, former Aetna CEO Jack Rowe, MD, consumer advocate attorney Sarah Rosenbaum and others are working to educate the public and patients about these problems, and try to encourage fair practices by the industry. AMA is also proposing a “truth in benefits” act in Congress to remedy these injustices and rip offs.

Has your practice seen non-payment as a result of scan insurance coverage?

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