Aug 27, 2020
In this Episode 290, Stacey Richter talks with Doug Aldeen, a health care and ERISA attorney, about the crafty gambits some (not all) hospital billing departments have used during COVID-19.
WHAT YOU’LL LEARN
✅ Why exploitive billing practices tend to show up when a hospital’s mission statement and its finance team are on two different planets
✅ What a hospital’s “scorched earth” billing policy looks like and who it can hurt
✅ Why hospital-owned insurance plans, or “payviders,” create their own set of exploitive billing risks
✅ How reference-based pricing (RBP) works and where it fits into the fight over fair pricing
✅ Why educating employees on what care actually costs is a critical part of the solution
WHY THIS MATTERS
Doug Aldeen has spent two decades negotiating with hospital finance teams on behalf of self-insured employers, and he lays out the gap between what hospitals say their mission is and how their billing departments actually behave — especially during COVID, when some hospitals leaned harder into aggressive billing tactics even as they were being financially squeezed by the pandemic. From scorched-earth collection policies to payvider conflicts of interest to reference-based pricing disputes, Aldeen walks through the mechanics employers and patients need to understand, plus what it actually takes to push back.
MENTIONED IN THIS EPISODE
🔗 EP242, with Marty Makary, MD
=== LINKS ===
🔗 Show Notes with all mentioned links: Episode Page
🔗 Healthcare Industry Acronyms and Terms
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00:00 Introduction.
03:59 Exploitive hospital billing practices.
04:20 The impact these exploitive billing practices have on patients.
04:45 Why would a hospital exploit the patient with their billing practices?
09:31 “You could adversely affect 3 million people.”
10:53 The “scorched earth” policy.
11:33 EP242 with Marty Makary, MD.
12:28 “I think the long-term plan … is preserving the network.”
13:08 EP186 with David Contorno.
16:03 A third exploitive billing process: hospital-owned insurance plans, or “payviders.”
20:35 MOOP: maximum out of pocket.
21:07 RBP: reference-based pricing.
21:58 Exploitive tactic #4.
26:03 The solution to changing exploitive billing strategies.
26:39 “You have to be willing to travel.”
28:34 EP240 with Olivia Ross.
28:47 “It’s educating your employees and really having an honest conversation about ‘This is what it really costs.’”
30:28 Doug’s advice to hospital execs listening right now.