So, I’ve had this little (that’s read as 2 inch deep, 2 inches across, 4.2 inches high) infection on my leg for a little while.

It actually appeared sometime around Halloween.  But, since it was on the back of my calf, I had no clue it was there.  (Of course, it didn’t hurt.  Otherwise, I WOULD have known it was there.)  A few folks would make a comment like, “What the heck is wrong with your leg?”, while we were waiting to pass COVID-quarantine restrictions and get some swimming laps in.  I would look down, see nothing, and shrug it off.

About the ides of November, a good friend made a remark, “You do know it’s 45 degrees outside and it is November, why are you wearing shorts?”.  Having received such comments all my life, I also shrugged that off.  But, she took a photo of my leg.  And, showed it to me.  (Now you know how I knew the size of the injury.)  She also sent it to my doctor (knowing full well I probably wouldn’t).

Stuart called me immediately and told me to come in the very next morning.  Which I did.  After examination, a little abrading of the wound, he told me to get to the hospital.  NOW.

Which I did.

And, for the next 36 hours, I underwent a series of IV infusions, blood draws (enough to leave me anemic!), doppler flow tests for my legs (to ensure that there was sufficient blood flowing through my arteries), chest X-rays (as far as I can tell, this was just done to raise my hospital bill), blood pressure interventions (you try staying in an emergency room for 36 hours while a woman in the next cubicle is screaming at the top of her lungs to let her go, to stop harassing her, etc.), and a few pokes and prods for which I might have missed the reason.

Why was I in the emergency room for so long?  Because there was no room at the inn (i.e., a hospital bed) due to COVID-19 issues.

And, why am I sharing this with you?  (Not because it turns out to be pneumonia on a leg.  Nor, was I the first to so contract this necrotizing fasciitis variant.)

Because (especially during the COVID-19 pandemic), it is not atypical for a hospital to use a doc or specialist that is NOT part of their staff. One that is not part of the approved vendors for your insurance.  Which means we get at least two bills.  One from the hospital at an approved rate (one our insurance company agrees is reasonable and customary [even if the hospital disagrees 😊 ), and one from this out-of-network professional at sky-high rates.  One that our insurance refuses to cover.

So, we are left with a savings-depleting bill that we were not expecting.

It has always been my belief that this is an engineered situation between the specialist and the hospital.  In that the sky-high charge doc shares part of his fee with the hospital, increasing their coffers, at the expense of the unsuspecting patient.

But, finally, I can say- ALMOST NO MORE!

This practice is commonly known as “surprise billing”.  About 1 in 5 visits to the emergency room (even though the patient is using the ‘in-network’ choice involve such ‘fraudulent billing’ scenarios).  It’s about  1 in 6 should one be admitted to the hospital.   Theoretically, the Affordable Care Act (Patient Protection and Affordable Care Act, aka Obamacare) stipulates that when we visit the emergency room, we can’t be billed a larger co-payment than if the hospital were participating in the plan.  But, an out-of-network hospital has no such stipulation on its actions.  Moreover, the rule doesn’t stop the patient from getting billed- just the insurer!

Which is why Congress has been promising to eradicate it forever.  (OK, not promising to act- but realizing it’s a problem).  Because, like almost everything Congress passes, it’s been all talk (or at least “some folks” talk) and no action.

Some states have passed laws outlawing this practice.  But, they don’t work if one is covered by company self-insurance.

The pandemic relief bill that just passed (finally) forced some action.  Unfortunately, they didn’t ban the practice for 13 more months- until 2022!  And, the regulations now require the insurers and the providers to go to arbitration.  Which arbitrators?  That isn’t detailed.  Moreover, the regulations specifically outlaw the arbitrator relying on the rates that Medicaid and Medicare willingly accept.  (After all, that would make the surprise bill far less daunting, since Medicare and Medicaid are effective arbiters of medical  costs.)

The real issue is that private equity firms (better known as stock bandits) have been buying up physician practices, pulling them out of networks, and raising their rates to pad their own pockets.  (Not the practitioners, the private equity firm’s coffers.)

This change is purported to save some $ 18 billion over the decade starting in 2022.  Now, if you can only avoid visiting the hospital until 2022.  (Obviously, I am NOT in that boat!)