BuyER Beware: Separate billing, surprise costs

A 9Wants to Know investigation has found doctors who work inside University of Colorado Hospital's chain of freestanding emergency rooms remain "out of network" with most insurance companies more than a year after the state's medical giant partnered with a Texas-based company to operate the ERs.

9NEWS @ 9. 12/26/2016 None

KUSA - A 9Wants to Know investigation has found doctors who work inside University of Colorado Hospital’s chain of freestanding emergency rooms remain “out of network” with most insurance companies more than a year after the state’s medical giant partnered with a Texas-based company to operate the ERs.

The problem, one which UCHealth is trying to remedy, continues to expose patients to high bills from the business that employs the doctors who work inside the ERs. In addition, 9Wants to Know has found evidence that UCHealth’s partner is on the verge of becoming even more aggressive in its bill collection.

It’s a move that could put more patients like George Brown of Aurora in tight spots, economically speaking.

Brown, a retiree, recently received a pair of bills for an hour-long visit to a UCHealth ER in Aurora for a bad cough. His insurance picked up the majority of the $2,000 bill from UCHealth. That wasn’t the problem, as far as Brown was concerned. The second bill, from National Medical Professionals, came to $1,626. 

His insurance carrier, Cigna, refused to pay any of it. Brown said he was told by a representative of Cigna that National Medical Professionals was not in its network. Only later did he learn National Medical Professionals employs all of the doctors who work inside every UCHealth.
  
Think of the company like a contractor. 

The bill – which amounts to about $27 of compensation per minute for the doctor’s group -- caught the retiree completely off guard.
 
“I knew doctors made a lot of money, but I didn’t know they made that much,” he said.

And while National Medical Professionals bills like a separate entity, it’s actually closely aligned with UCHealth’s partner in the freestanding ER venture. Since the spring of 2015, Adeptus Health has held a 49.9% stake in UCHealth ERs.  Adeptus’ Executive Medical Director, James “Mike” Muzzarelli, is listed under the same title on National Medical Professionals website.

In fact, Adeptus and National Medical Professionals share the same address in Lewisville, Texas, according to the companies’ financial disclosures.

It’s not exactly an unusual relationship, as many doctors in emergency medicine tend to bill separately from the actual facility in which they work, but in Colorado’s growing freestanding ER market, the billing practices highlight yet another barrier to cost transparency in health care.

Patients who carefully choose an emergency room based upon whether their insurance company considers it “it network” could unwittingly expose themselves to “out of network” bills from the very doctors who attempt to diagnose them.

And, as you’ll see, Adeptus Health intends on strengthening its efforts to get its patients to pay those bills on time.

DOCTORS NOT EMPLOYED BY UCHEALTH 

It was last year when UCHealth threw itself head first into the ever-expanding freestanding ER market in Colorado. 

Buyer beware: Freestanding emergency rooms

An April 21, 2015, press release spelled out a new partnership in its first paragraph.

“University of Colorado Health is partnering with Adeptus Health to improve access to high-quality emergency medical care for patients throughout Colorado Springs, northern Colorado and the Denver Metro area.  UCHealth will hold a majority stake in Adeptus Health’s freestanding emergency rooms in Colorado,” the press release read.

At the time, Adeptus was operating a dozen freestanding ERs under the name “First Choice Emergency Room” in Colorado.  The announcement, for most patients, was largely a superficial one as the only thing that really changed on the surface was the signage on and in front of the 12 locations.
Behind the scenes, however, the move allowed UCHealth to dominate the freestanding ER market in Colorado.  Freestanding ERs, as their name implies, are emergency rooms that are not physically attached to a hospital.

By November of last year, UCHealth operated 14 of the 24 freestanding ERs in Colorado.  The rest were run by a variety of businesses and hospitals.

It was about that time, a spokesperson for UCHealth told 9Wants to Know the hospital giant was working hard to bring more insurance carriers into an agreement with its chain of facilities.

Finally, in September of this year, UCHealth announced the ERs would accept Medicare, Medicaid and Tricare.

Today, all UCHealth ER locations also accept Anthem, Humana, Rocky Mountain Health Plan, PHCS, Denver Health Medical Plan, Multiplan, UCHealth Plan Administrators, and Beech Street, according to UCHealth spokesperson Dan Weaver.

“Additional contracts are now in the works,” Weaver added.   

The doctors who work in the ERs represent another story altogether, however.

“The emergency physicians who practice at UCHealth ER locations are not employed by UCHealth and must negotiate their won contracts with insurance companies,” said Weaver.

As of Dec. 1, the only contracts National Medical Professionals had signed were with Anthem, Multiplan, PHCS and Beech Street.  (National Medical Professionals also accepts Medicare, Medicaid and Tricare)

Weaver said UCHealth “has made introductions to help facilitate [additional] negotiations between the physicians and insurance companies.” He said he hopes to announce more agreements as soon as the start of 2017.

It’s of no use to patients like Brown, however.

When he left the UCHealth ER on East Mississippi with a prescription in hand back in June, he had no idea what was about to come his way.    He thought his insurance would simply “handle it.”

Little did he know, National Medical Professionals had no agreement with his insurance company. 

It’s a problem a recent New England Journal of Medicine article outlined when it suggested as many as 22% of Americans who visit an “in network” ER receive “out of network” bills from the doctor.

“I think that’s outrageous,” said Brown.

ADEPTUS HEALTH FACING TOUGH TIMES

Thomas Hall, Adeptus Health’s CEO, started off his 2016 third quarter earnings conference call with an admission.  Unbeknownst at the time, Hall would abruptly leave the company in less than a week.

“We are clearly disappointed with the results we are reporting today,” he said on November 2.   His company’s stock price was already tanking.

By the time the market closed, it had lost 68% of its value as it dipped under $9.00.  The day before it
was at $26.87 a share.

Just one year prior, it was closer to $60.

The sharp drop has triggered a pair of federal lawsuits filed on behalf of investors alleging Adeptus has engaged in “predatory overbilling practices” and that nondisclosure of that constituted an unreported risk.

Both suits, filed in Texas federal court, cite a November 2015 investigation by 9Wants to Know that documented a series of complaints from Colorado patients who received four-figure bills for relatively minor health conditions.

In one instance, for example, a patient received a $2,200 bill for the removal of a large splinter from his thumb.

The lawsuits even go as far as to suggest the report was the reason behind a sudden 22% drop in Adeptus stock on Nov. 17, 2015.  Our story had aired the day prior.

In response to a series of questions 9Wants to Know sent to Adeptus, a spokesperson said, “Adeptus cannot comment on ongoing litigation or business strategy at this time.”

But during that third quarter conference call, its then-CEO hinted some of the company’s financial woes could be attributed to patients not paying their bills on time.

“We’ve got to be more aggressive on collecting the patient side of the equation as well.  Because, as you know, more and more, you look at what’s going on in the market, more and more the bill is shifting to the individual and we’ve got to be more aggressive on ways of collecting what’s owed to us from the patient as well,” he said, according to the call’s transcript.

“We’ve got to get after the individuals who can pay,” he added.

It remains unclear what Hall’s words might mean for people like George Brown.    UCHealth handles the billing for use of the ER facilities in Colorado, but National Medical Professionals – headed by a key leader in Adeptus Health – handles the billing for all of the doctors.

Brown continues to struggle to pay off the $1,626 bill he received for the doctor’s treatment of his bad cough.  

He’s decided he can only pay $50 a month.

“It’s all I could afford to send them,” he said.

At this rate, he’ll be paid off sometime in late 2019.

All for an hour visit to an ER he thought he insurance company would “take care of.”

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