You know what's messed up, that I had to call the hospital to make sure the anesthesiologist would be in network for my daughter's birth.
— Loren Adler (@LorenAdler) November 28, 2016
What normal person not entrenched in this issue would think to do that naturally, when you know the hospital is in network?? https://t.co/fnp7M40UyF
— Loren Adler (@LorenAdler) November 28, 2016
Loren is a healthcare wonk. He knows this shit cold and he is right, no one in their right mind would think to call the in-network hospital to see if the anesthesiologist would be in-network if a laboring mother to be needed/wanted an epidural.
As other wonks in the tweet stream noted, the best that he could hope for is the hospital to give him a non-binding informational advisory that their anesthesiologists were or were not in network. And even here, the information is incomplete. Many carriers will offer a number of different networks in the employer and individual markets. Some carriers will tell providers that they are in seven of the twelve networks offered. In those cases, the office manager or the billing clerk might be able to tell an interested patient who is trying to effectively shop for planned care whether or not Dr. Smith is in-network for them. Here the system may not be working but it is not flailing around completely in a fireball of fail.
However not all carriers will do this. Instead they’ll send Dr. Smith seven contract amendments for the seven current networks that they want Dr. Smith in. They will never send him the other five narrow network amendments to sign or reject. So when a patient is trying to conform to the system that we impose on them, the billing manager will honestly say “Yep, we take all plans from Mayhew Insurance….” and three months later as the claim is submitted and everyone expects an in-network charge, the patient gets whacked with an out of network bill.
Our provider information systems are designed to fail in a Kafka-Goldberg-Dilbert menage a trois.