Prime Healthcare is growing in size, lagging just a bit behind Kaiser in size. By not having signed contracts, the hospitals can bill at their rate of service charge, so there are no breaks for the insurance companies. The hospitals see everyone in the ER rooms and are pretty much a lot of just that, one big ER operation, of course, they are functioning hospitals as well, but when acquired, many of the non profitable operations of the hospitals were removed.
It puts patients and doctors in the middle with the balance billing situation and they are taken care of at a Prime hospital which is “out of network”. In the last couple of weeks, Prime has purchased 4 more hospitals and is suing Kaiser now for balance dues they have not paid on the bills sent. Again, this balance is due to the fact that there are no contracts in place for any HMOs or insurers, so they are billed the published charges.
Dr. Reddy states Kaiser should pay the bills, not the patient. "We really don't want the patients to pay us," Reddy said. "Patients are the only messengers to the health plans. They should call and say, 'We paid you dearly, how come you don't pay for my emergency care?'
Kaiser is now suing Prime to block the balance dues….but in a couple of instances, some of the hospitals purchased would not be around otherwise if not purchased by Prime as they were on the verge of insolvency.
This is just one fine mess, and back to the same old question, will somebody pay the bill? The insurance companies are busy expanding efforts to China at present, so it makes you wonder if they still place enough value on patient care here or is it off to the next frontier. BD
California regulators have moved to stop one of the state's biggest hospital operators from billing privately insured patients for unpaid medical services received at its facilities. The Department of Managed Health Care, in a lawsuit filed Friday in Orange County Superior Court, is seeking to bar Prime Healthcare Services Inc. of Victorville from billing insured patients for unpaid medical bills that the hospital chain contends it is owed from insurers and is seeking from patients as a last resort.
Prime often cancels most private insurance contracts when it acquires a hospital, causing that many of the patients treated in its emergency rooms or who are admitted for longer stays are "out of network," allowing Prime to charge higher fees for their care.
California sues Prime Healthcare over balance-billing practice - Los Angeles Times
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