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Negotiator: Patients need help with billing wolves

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Adam Russo is worried that the Trump administration and Republicans in Congress will do too little to change the U.S. health finance system in the next two years, not too much.

Russo, a Boston-based lawyer, is the owner of the Braintree, Massachusetts-based Phia Group, a company that helps insurers, group health plans and other clients challenge inflated medical bills. He’s also a director of the Simpsonville, South Carolina-based Self-Insurance Institute of America, a group for providers and users of employer self-insurance arrangements.

Related: Self-insured group prepares to prepare for Trump

Russo laughs at the idea that Republicans will be able to make the Affordable Care Act, and the tens of thousands of pages of regulations and guidance surrounding the ACA, go away quickly.

“It’s laughable,” Russo said Wednesday in an interview. “It’s not possible. It’s insane.”

Meanwhile, he said, Republicans, and others, are correct when they say they ACA does almost nothing to control the actual cost of health care.

Republicans have talked about expanding health savings accounts and empowering patients and physicians to take over the management of care. That’s a start, Russo said, but he argued that policymakers have to take that idea a step further, and give consumers the tools they need to fight over-billing as well as financial incentives to notice over-billing.

Health cost drivers

Dr. Elaina George, an ear, nose and throat surgeon in Atlanta, told a in an interview Tuesday that she believes big health insurers, drug makers, hospital companies and federal agencies have worked together to set up “care management” and “cost control” efforts that impose more red tape on doctors and patients, and work mainly to benefit the big insurers, drug makers and hospital companies.

Russo, who is not affiliated with George, said he agrees with her assessment of the situation.

In most cases, the high cost of care “is not the doctors’ fault,” Russo said.

Russo said he believes the current system gives hospitals an obvious financial incentive to inflate their bills, and to send out multiple bills for the same procedure.

The Affordable Care Act ban on annual and lifetime major medical benefits limits has aggravated the problem, by eliminating one force that tend to rein in billing, Russo said.

Russo listed three steps for cutting U.S. health care costs:

  • Make health care providers post their real prices online, so that patients have an easier time shopping for low-cost, high-quality care.

  • Give consumers a share of any savings they achieve by identifying inaccurate medical bills.

  • Put patient advocates or other professionals in charge of talking to the medical billers about the inaccurate bills.

Today, Russo said, issuers of high-deductible health plans seem to be taking their own inability to police medical bills and passing that headache on to the patients.

To maximize the power of patients to hold down bills, plans need to give patients help with dealing with the inaccuracies they find, Russo said. 


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