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One visit, one ultrasound, two copays

June 25, 2019 06:51 PM

ROCHESTER, N.Y. (WHEC) — If you've ever been confused and upset over your doctor bills, you are not alone. 

One of our viewers shared his problem with News10NBC. He says he went to one procedure in one building and yet he got two bills. 

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This is the kind of confusion that could be addressed by President Donald Trump's order on making medical bills easier to understand.
The procedure Ron Walker gets isn't optional. It can help save his life. But he's getting billed twice to do it. 

"I went for my procedure on 4/19," Walker said in the sunroom of his home in Canandaigua.

The procedure was an ultrasound on his aorta. Walker is ordered to get it every six months. 

Chief Investigative Reporter Berkeley Brean: "So this is something you have to do."

Ron Walker, two co-pays for one procedure: "Twice a year. Yeah, I have to do that."

But here's the issue. Even though he went to one place for one test, Walker ends up getting two bills from UR Medicine for two copays. 

One for an office visit. One for a lab visit. 

Walker: "That's my complaint. Double copays."

So for the last couple of days, I've been sharing Walker's problem with UR Medicine. With his permission, I even shared his medical bills. In an email today, UR Medicine Director of External Communications Chip Partner wrote some insurance companies require them to bill for both the procedure and the facility. 

Partner's email says "that is most likely the case here."

Christopher Bell, Monroe County Medical Society: "Yeah, I think this is a really good example of the sheer complexity of medical billing."

Bell is the head of the Monroe County Medical Society. 

Brean: "Shouldn't it be more simple?"
Bell: "It would be really nice if it were. I think it speaks to the value we hope to see coming out of President Trump's executive order which he signed earlier today."
Brean: "Which will do what?"
Bell: "Well hopefully, among other things it addresses multiple leaders in his cabinet to produce reports with tangible solutions and ways to protect patients from surprise billing as well as better understand the cost that goes into their care."

The American Medical Association released the following analysis and bullet points of the president's order for more transparency in medical billing. 

"The purpose of the order is to direct federal agencies to issue regulations to improve the transparency of health care prices and quality in order to create a more competitive marketplace and provide consumers with the information they need to make informed purchasing decisions.  More specifically, the executive order:

  • Directs the Secretary of Health and Human Services (HHS) to issue regulations within 60 days that would require hospitals to publicly post standard charge information, including information based on negotiated rates, in an easy-to-understand format.
  • Requires the Secretaries of HHS, Treasury, and Labor to issue an advance notice of proposed rulemaking within 90 days seeking comment on proposals to require health care providers, insurers, and self-insured group plans to provide consumer access to information about expected out-of-pocket costs before they receive health care services.
  • Requires the Secretary of HHS, in consultation with the Attorney General and the Federal Trade Commission, to issue a report within 180 days on ways the federal government or private sector impede health care price and quality transparency for patients, with recommended solutions.
  • Directs the Secretary of HHS, within 180 days and in consultation with other federal departments and agencies, to increase access to de-identified claims data from taxpayer-funded health care programs and group health plans for researchers, innovators, providers, and entrepreneurs to facilitate the development of tools that empower patients to be better informed purchasers of care.
  • Requires the Secretary of the Treasury, within 180 days, to propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care and health care sharing ministries, as eligible medical expenses for Health Care Savings Accounts, and to increase the amount of funds in flexible spending accounts that can carry over at the end of the year without penalty.
  • Directs the Secretary of HHS to submit a report to the President within 180 days on additional administrative steps that can be taken to address the issue of surprise medical bills."

The White House also issued a corresponding fact sheet.

Credits

Berkeley Brean

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