I received this response to my post Swedish Ballard Promotional and Update on Appeals:
I appreciate the comments made above and understand the frustration regarding whether or not a physician group contracts with a particular health insurer. Ballard Emergency Physicians has recently reached agreement with Premera. Both Swedish/Ballard and the Ballard Emergency Physician group are now participating providers for Premera medical insurance programs. Feel free to contact me if you have any other questions.
Rayburn Lewis, M.D.
Executive Director and Senior Medical Director
Swedish/Ballard
As I have in previous posts – I will extend thanks to Rayburn Lewis, MD, for taking the time to visit and read my post, and respond personally. I’ve sent him a rather slapdash email asking for more information. Let’s face it, I’m a low-level blogger, not some pro-aspiring-journalist. I know some people have been landing on this blog thanks to Google searches, so I hope to give you the most up-to-date info as I get it.
As for my appeal – I finally heard back from Premera on my second appeal. Not surprisingly, they denied my claim, but were sympathetic in doing so. Apparently, I have a packet of info in the works, with additional appeal information (it doesn’t stop at 2?!) I called the Ballard Emergency Physicians billing office (of Oklahoma City, OK), and they seemed unfamiliar with the agreement, and weren’t aware of any implications the agreement would have on my bill. They did, however, give me a “courtesy discount” of 30%, making the final bill smaller, but still above what it would be if it was billed in-network.
I have a bit more digging to do, but this odyssey is nearing its end, I think. This wasn’t really about lowering my own costs, though that is a benefit – it’s about the principle. I’m sick of hidden charges and fees. I’m sick of a system where you can’t leverage the principles of capitalism in the market place to ensure the best deal. You walk into any ER, and you can spend the same amount of time seeing a doctor, get the same tests, and end up with a radically different bill at any given time.
Today, a woman I talked to at Premera WAS able to give me, over the phone, a list of hospitals that do not have contracted providers in their ER (a previous representative was unable to do so months ago.) Luckily, if what Dr. Lewis is saying is correct, this has changed for the hospital nearest to me.
If the people in the health care industry are so scared of reform – then I ask the health care industry to reform itself so legislators don’t have to. The current system is broken, it wastes money, it sets pricing at ridiculous levels, and even non-profits get tied strongly to the profit base. I don’t have the answers, but I, like many people, have some ideas. I prefer companies that have the sense to carry internal ethics, and hold true to practicing them than other agencies having to tell them to do so. Step up, I say!
Anyway – I’m done messing with medical stuff today. After all, it’s hot out there! I need to drink more water and get myself to the library!
See previously: Emergency Room Charges, Ballard Emergency Physicians and Swedish Ballard Emergency Room, Insurance, Emergency Room and Complaints/Appeals, Insurance Appeal Update, Ballard Emergency Physicians Update, Swedish Ballard Promotional and Update on Appeals
Tags: ballard, ballard emergency physicians, health care, medical, premera, swedish medical center, washington state