When a patient is covered by Medicare, BCBSM, or other large insurer the patient is protected from fee gouging because by contract a participating provider or hospital has to accept the stipulated fee or charge. Medicare even protects the Medicare patient from the non-participating provider by establishing a fee by law that they have to accept. When an uninsured patient or a patient goes to a non-participating provider they are not protected from fee gouging. In medical or dental settings the patient has no control over the fees and many times who provides services.
I participated with all the major insurances including Medicaid. By contract I accepted the fees paid and did not balance bill the patient. I charged the uninsured patient at or below the Medicare fee schedule. I feel that physicians can make a nice living from Medicare fees or the other major insurance companies' fees, but not Medicaid fees.
Many times my patients complained about fee gouging when they were not protected by contractual obligation or by the law. It has even happened to my family and me. For example medical tests sent to a
non-participating lab which then bills astronomical fees and states they are the standard charges which the patient must pay.
The patient as the consumer needs price protection by law from health care fee gouging. I am for a national Single Payer or Medicare For All health care system that will protect the patient from health care fee gouging as Medicare already does for the Medicare patient. However, that will not happen for a long time. Therefore, I will propose legislation that will be similar to the way that Medicare protects the Medicare patient from fee gouging for all Michiganders.
Ted Golden, M.D.