Our 2019 New Year’s Resolution : Helping Our Patients and All Healthcare Consumers Understand What Great Care Means
Welcome to a new year! 2018 was an exciting year for Premier as we expanded our reach with new locations in Texas. Thanks to the great feedback we received, we hope to make 2019 even better! One of our main goals this year is to inform our patients and the public about upcoming healthcare legislative issues that affect us all in Texas.
Every 2 years, the Texas Legislature meets to pass new policies and legislation that aﬀects all Texans. One of the most important topics this session is healthcare. We want to highly encourage every Texan to be informed of these issues. Below is a snapshot of the issues we believe are among the biggest concern, how Premier is addressing them, and what we believe can be done to remedy these issues for Texas as a whole.
Insurance In-Network Status
In-Network status is where the provider or facility agrees to a pre-negotiated reimbursement for services oﬀered with an insurance company. In turn, insurance companies typically “sell” this network to the insured. Out-of-Network has no such agreement and can often confuse patients on what their responsibility is per their insurance contract, delaying the entire process.
At Premier, our facilities have always had the full intent of being In-Network for everything we do. We are pleased to say we have agreements with most major insurance companies already, and are approaching 2019 with the hope of having all major insurance carriers on-board with us. Please visit our website for updated information: www.premier.care/insurance
We believe Legislative action should encourage all practices to be In-Network, and at the same time require fair and appropriate reimbursement and timely contract negotiations by the insurance companies.
Balance billing only applies to Out-of-Network providers. This results in the patient getting a bill that is the diﬀerence between the original bill and what the insurance company elected to pay. For Example, a $3,000 bill is sent. The insurance company pays $1,000 and then the patient receives a bill for $2,000.
Premier has never nor will ever balance bill a patient.
We believe Legislative action should protect consumers on aggressive and inappropriate balance billing techniques from providers who don’t produce clear and transparent business practices.
Deceptive Advertising of Emergency Services for Urgent Care Needs
This topic is difficult for consumers to understand as there isn’t a precise definition of what constitutes an urgent care and its services. Meanwhile, freestanding Emergency Rooms have very specific rules on how they are defined and what they can advertise for. The loose urgent care definition has led to some freestanding ERs muddying the waters and attempting to steer urgent care patients to their facilities. Specifically, many freestanding ERs deceptively state they can do immunizations, take care of flu and allergies, and even talk about urgent care issues on their website and marketing materials. Many patients have already seen evidence of those out there who are abusing this practice. They are deceiving consumers into coming to their facility for non-emergency services. This hurts the whole system by creating distrust in patients who show up at an ER for a minor ailment thinking they are going to an Urgent Care and end up with a large bill that could have been handled in a much more appropriate facility.
Premier is one of only a select few companies that offer an ER and an Urgent Care under one roof. This relieves patients from having determine how serious something is while knowing they will get the appropriate level of care at an appropriate cost. To date we have seen 70% of all patients in our Urgent Care. This has resulted in millions of dollars of savings for unnecessary ER charges with appropriate care being given to patients.
We believe that Legislative action should protect consumers who practice deceptive advertising by once again those providers who are not transparent in their business practices.
Observational billing is the practice of keeping a patient at an ER for Observational Services Status for less than 23 hours instead of admitting a patient to a hospital for further care, observation, or sending them home. At its core, this isn’t bad when done appropriately (observing if the patient will either improve or decline in the safety of medical supervision), but it has been grossly abused by the freestanding ER community. Among those who abuse this practice, it has become typical to see observation practices of ankle fractures and stomach aches with hourly fees from $1000-$4000 an hour. Many operators cannot sustain their facilities without this type of billing practice and has been one of the factors in such high ER bills. In these cases it’s at best excessive and at worst an abuse of a good and logical practice.
Premier has never practiced any observational billing practice and will always take care of the patient in the best way possible. This may include keeping them at our facility to make sure a patient can go home later or transferring them to a hospital for a more long-term care approach (1-3 days for example) without the need to excessively bill for that service.
We believe that Legislative action should protect consumers who practice observational billing as their business practice.
We believe that too many deceptive practices have been occurring in the healthcare arena that need to be addressed and communicated to the consumers who are at the mercy of these practices. Though we don’t claim to have all the answers, we do think meaningful steps can be taken to protect patients from being taken advantage of.
Overall, we believe Texas can inspire changes by showing how to best take care of people in a trustworthy way. Premier was founded to provide the best possible care for our patients, and we will continue to give a voice to their concerns in healthcare. We look forward to continuing our mission of providing an unparalleled patient experience in 2019 and are thankful for the passionate feedback our patients have given us to help us achieve this mission so far.