Bunion Repair at $66,100 Spurs Aetna Lawsuit Against Clinics

[MrScorpio]

By Peter Waldman
Feb. 3 (Bloomberg) -- Aetna Inc. is suing seven California surgery centers for a billing system that it claims “recklessly subverts” health care delivery with charges of as much as $66,100 for a bunion repair.

The lawsuit seeks to stop the centers from waiving the co- insurance payments people are supposed to be charged when they use doctors or facilities that don’t have contracts with their insurers. By not requiring such payments for so-called out-of- network care, the centers illegally lured patients, and then billed Aetna up to 2,500 percent more than what the company pays its contracted providers for procedures, according to the suit.

Aetna claims the centers shared the profits with doctors who own the facilities, giving them incentives to refer clients with the most generous insurance plans.

The “scheme must be promptly declared illegal to preclude its continuation and replication throughout California, and to avoid the potential consequences of irreparably damaging a system of healthcare delivery on which millions of citizens rely,” according to the suit, filed in California state court in Santa Clara County.

The complaint names 11 defendants, including Bay Area Surgical Management LLC, known as BASM, and six centers it manages. BASM’s general counsel, Brian Blatz, called the allegations “baseless” and said Aetna is retaliating against BASM for two suits it filed against Aetna seeking to collect on unpaid medical bills. Those cases haven’t gone to trial.

http://www.businessweek.com/news/2012-02-06/bunion-repair-at-66-100-spurs-aetna-lawsuit-against-clinics.html

Only in America.

[msongs]

1. 66K sounds out whack, insurers need to take legitimate action to keep fraud down nt

[niyad]

2. gee, they sell bunion pads at the dollar store

[frazzled]

4. Pads don't correct a crippling condition

People don't really understand what a bunion is. It's not some bump on your toe; it's the collapse of all the bones of the foot, which causes the joint, then, to protrude increasingly outward. Surgery is usually called for when a person can no longer walk without excruciating pain.

Usually, the bone of the largest joint has to be broken and then realigned and pinned together. It's not minor surgery.

Experts say about 90% of bunion surgeries now involve breaking the bone to reposition the joint and straighten the toe. A wedge of bone may be removed or an area may be fused to keep it in position. Pins may be inserted. Ligaments, tendons and nerves often must be realigned as well as bones. In some cases, a cast may be needed, experts say. ...

"To do it right, we must attack the source of the problem by realigning the toe joint, and this requires about eight weeks of recovery and rehabilitation in most cases. There's no quick fix." Full recovery, Hutchison says, may take a year.

http://www.usatoday.com/news/health/foot2001/2001-06-06-bunions-main.htm

I don't think it should cost anywhere near $66,000. But I wouldn't be surprised if it ran $5,000-$10,000. My husband got slammed in the hospital for a staph infection a year or so ago, simply to be on an antibiotic IV for 36 hours, and the bill (we didn't pay anything, but still, it was the cost to the insurance company) was $9,000.

[trackfan]

5. It's true. My sister had bunion surgery, and it involved a month's-long recovery process,

with various stages of casts, physical therapy, etc.

[niyad]

6. obviously I forgot the sarcasm icon

[Lint Head]

3. Just another reason to completely eliminate insurance companies involvement in health care.

They are nothing but banks and do not provide health care. The fact that they are multi-billion dollar companies that profit off of sickness and death open them up to fraud. I have worked in the claims, overpayment recovery and fraud departments of a major insurance companies. Believe me management for all of these companies are greedy sob's.

[Nuclear Unicorn]

7. There's something to be said for getting people out of ridiculous shoes.

Some of the things passing as fashion in the past several decades would offend Torquemeda in their barbarity and disregard to human suffering.