When someone receives care in an out-of-network hospital, the hospital and the insurer typically duke it out to determine a fair reimbursement. But Blue Cross has come up with a new idea: Rather than settling such disputes with the hospitals, Blue Cross is sending its members a check for what it deems fair payment. That leaves the hospital with a not-so-great choice: Either try getting the patient to turn over the check or wind up with zilch. From the Daily Journal (no link):
The check for $512,000 that showed up in Daniel Martinez's mailbox last month was not from the lottery, it was no windfall at all. The money was from Martinez' health insurer, Anthem Blue Cross, and it was supposed to pay for treatment his wife received for liver disease at Huntington Beach Hospital. "I thought, 'Why are they paying me?'" said Martinez, a security specialist for the Boeing Co. "I did not know what to do. It was a freaking burden to be honest."
"If someone is six months behind on their house payments and they get this check for $60,000, what are they going to do?" said Will Garand, director of managed care at Methodist Hospital of Arcadia. Since the hospital canceled its contract with Blue Cross in January, the health insurer has mailed more than $1 million in outstanding bills directly to patients and Methodist has scrambled to collect the money.