December 20, 2011

Letters to the editor, Dec. 20, 2011
Challenges in paying for health care

I am a nurse. I work in a busy emergency room and it is a job I love. I enjoy helping others through a time of need or crisis. It is an occupation I feel honored to be involved with.

click image to enlarge

Uninsured Americans often get their health problems taken care of in emergency rooms, at great expense to everyone.

2001 staff file/John Ewing

Every day, I take care of those without health insurance. Every day, I hear the concerns about paying the bill. I see people choose treatment based on ability to pay. In many cases, patients decline treatment that is needed solely based on payment concerns. They are among the 50 million or more in the United States currently without some sort of health care coverage. Let's call them the 16 percent.

The uninsured have no noticeable movement, no "occupy" status, just the ever-present fear of losing their homes, cars or not being able to survive because of health care bills. Good luck getting out of an emergency room in this country for less than $1,000. That's one of the only options the uninsured really have, a trip to the ER.

Many nursing groups across the United States, including the Maine State Nurses Association, have been active in supporting HR 676, a bill that would allow all citizens access to covered health care. It is also known as single payer insurance. It is fair, it includes all and it's needed.

Long have health care insurers been making record profits off the backs of the sick and injured – a practice many consider to be unethical.

In light of recent economic instability and the ever-growing knowledge of corporate greed and mismanagement, it seems even more so today.

One of our greatest presidents, Franklin D. Roosevelt, said in his Second Bill of Rights that all Americans have "the right to adequate medical care and the opportunity to achieve and enjoy good health."

It's time we act on behalf of all Americans and listen to the voices now echoing a voice from the past.

Steven P. Moody

North Waterboro

Hospitals, including some here in southern Maine, find themselves with budget shortfalls and are finding innovative ways to make up for those shortages. Many have resorted to mergers or acquisitions of previously independently owned medical practices. They then request from Medicare what is called provider-based status for those facilities.

Medicare will reimburse doctors at a higher rate when they are part of a hospital medical staff. That doctor can be located as much as 35 miles from the hospital campus and seeing patients in the same office and location as before.

Patients are not being told when making an appointment to see a doctor about a new billing practice that results in a facility charge that Medicare and most secondary insurance will not pay and the patient is forced to pay out-of-pocket. Questioning the charge will often result in very misleading and evasive answers designed to totally obscure the real reason for the charge.

The hospital knows that once a patient is informed, he will logically seek medical care from another doctor in private practice who will not or cannot charge such a fee. Medicare requires that once a hospital bills just one patient this way, all patients must be billed the same way, Medicare patient or not.

Quite simply, be informed and inquire about these charges when making an appointment.

Actually, Medicare requires the hospital to inform you when making an appointment but they typically do not for obvious reasons. It is said that these new provider-based facilities can generate as much as $30,000 of extra revenue per doctor per year for the hospital.

Search "facility charge" or "provider based status" on the Internet to learn more about this.

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