In an effort to better manage health care spending pending legislation adds more administrative costs and record keeping requirements. Health insurance companies are typically the targets for creating administrative costs which increase health care charges by providers, but the real culprits are federal and state laws and regulations. Here is a recent example.
The draft “Lower Health Care Costs Act,” would require health care facilities and health care providers to give patients a list of services received upon discharge, and would require all bills to be sent to the patient within 30 business days. If a patient received a bill more than 30 business days after receiving care, the patient would have no obligation to pay.
Medicare doesn’t even process claims within 30 days and when there is supplemental coverage files are transmitted every three months for processing. How will the provider know what to bill the patient in 30 days?
Providers and health plans would be required to give patients good-faith estimates of their expected out-of-pocket costs within 48 hours of a request by the patient.
Interesting; I wonder how providers will know where their patient stands in terms of meeting out of pocket provisions of their health plan or how the health plan will know all the services to be provided?
The legislation also prohibits PBMs from keeping rebates, discounts or other payments from pharmacy companies. Okay, PBMs will simply increase their fees to health plans and employer plans. In addition, large employers have had agreements for years under which the plan receives the rebates.