By Libby Cluett
lcluett@mineralwellsindex.com

In the past, some insured patients visiting Palo Pinto General Hospital’s emergency room left happy about their medical treatment, but their smiles turned to frowns when they later received a bill for the full amount of the ER doctor’s care.

Recently, Santo resident Georgia Bounds received a “professional fee” (doctor’s) bill for over $900 after her visit to PPGH’s emergency room. She said she was shocked that an in-network hospital had “doctors” who would not accept her major insurance – Blue Cross Blue Shield of Texas – supplied through her federal government employer.

“The emergency room care was good … I had no complaints with the doctors,” recalled Bounds. “What I couldn’t understand is why the ER doctors were not also in the network [as the hospital].”

“I could have afforded to pay that but I know there are people who couldn’t. I just didn’t think it was right,” she added.

When she first called the Index, a reporter suggested she call her insurance company regarding the bill for the full doctor’s fee; she did and finally got her bill settled.

“After I spoke to my insurance company, they reduced it to $350,” said Bounds. “You get such a vague bill; it just didn’t make sense to me.”

But not everybody calls, and some pay the full “balanced bill” as presented.

“It takes time,” Bounds said. “If I didn’t have the money for it, I’d be real upset; I’d still be paying on it. It just didn’t sound right to me. It sounded unjust. How many people paid who didn’t have the money?”

But, according to hospital CEO Harris Brooks, it wasn’t the doctors but the company, EmCare, a publicly traded company that contracts emergency room physicians. Brooks said EmCare would sometimes “balance bill” patients whose insurance company was out of the company’s network.

As in Bounds’ case this meant sending the whole ER professional (physician) bill to the patient, despite the patient having insurance that included ER services.

It’s not just PPGH patients who experienced balance billing when their ER doctor was out of their network. Brooks said that EmCare also provides ER physicians to hospitals like Weatherford Regional and Graham Regional.

In December The Weatherford Democrat reported that Parker County Court at Law No. 2 Judge Ben Akers approached Parker County commissioners with concerns about this practice.

Akers cited confusion that physicians practicing at an in-network hospital, like Weatherford Regional Hospital, were not required to be in-network providers, leading to sky-high medical bills, according to The Democrat.

The judge said some county employees “feel blindsided,” especially when they think all that’s required for a participant’s emergency room visit to an in-network hospital is the $100 copay.



Changes

But PPGH officials expect this practice to cease and desist this week. Earlier this spring the board of trustees voted to change its emergency room physician provider service to Concord Medical Group – a family-owned company based out of Muleshoe, Texas.

The changeover starts today. According to hospital CEO Harris Brooks, the transition will be “like night and day.”

Brooks said Concord will recognize out-of-network insurance companies and negotiate with them before sending a balanced bill for the full amount of an ER doctor’s fees.

“Concord will negotiate with the insurance companies, [which means] you will not see a huge balance,” said Brooks.

“Patients that have insurance will still have to pay the normal out-of-pocket expenses, but they won’t be faced with 100 percent of the [physician’s professional fee] bill,” said Brooks. “It’s a slap in the face [for patients to have] to pay for insurance and the insurance doesn’t cover ER physicians.”

Executive Vice President Matt Brewington, confirmed that Concord will negotiate with a patient’s insurance company before the company bills patients.

Zach Sheets, Concord VP and the oldest of 10 kids of company founder Dr. Kyle Sheets, a Muleshoe community physician said, “We’re family owned and operated and we actually care.”

“Our approach with any hospital we work with is to always care for the community first,” said Zach Sheets. “More than anything, I think that medicine has moved in the direction that it is not enough to take care of someone’s medical needs, but a company must take care of customer service needs.

“I’m glad that they are doing that,” Bounds said when she learned PPGH is switching to another emergency service provider company. But she said she hoped it didn’t mean there would be a change in doctors.

There’s some good news there. Although the administration of ER physicians will change, Brooks said PPGH will retain the primary group of ER physicians – Dr. John Jones as the Emergency Medicine Director and ER physicians Dr. Robert Allensworth and Dr. Michael Bailey.

The bottom line for those who have insurance covering emergency treatment, is that Concord would work hard to coordinate with PPGH “to offer the best possible price and go to insurance companies before coming to the patient,” according to Sheets.

“We won’t badger a patient. There are cases where a person doesn’t have insurance and we’ll have to bill that patient,” said Sheets. He added in this case Concord will try to work with patients and be accessible and available for them.

He said the company’s goals include making “sure physicians are treated honestly and the community is treated fairly and making sure we bill accurately. The major difference between us and other companies is we are very approachable. We take a hands-on, proactive approach to customer service.”

“We plan on having a longterm relationship with Mineral Wells,” which Sheets said means, “No matter what, patients will find a difference with Concord Medical Group, and it will be a good difference.”