Hospitals Beware
Insurance companies are getting even more creative in their legal language to avoid paying for services.
Aetna is incorporating language on serious medical errors into its hospital contracts and will attempt to avoid paying for so-called “never events.”
These “never events” are 28 medical errors identified by the National Quality Forum that are so egregious to patient safety that they should never happen. Some of these include operating on the wrong body part, leaving a foreign object inside a patient after surgery or a patient death or disability associated with a fall.
Aetna’s newest template for hospital contracts mandates that hospitals report these “never events” to an accrediting agency within 10 days. Hospitals are then asked to take steps to ensure the error won’t be repeated, waive all costs related to the event and apologize to the affected patient and family members.
Aetna says it is the first health plan to endorse this approach to never events.
Since the CMS announced last fall it would halt reimbursements for some never events, payers such as the Blue Cross and Blue Shield Association have said they will follow suit.
Hospitals will need to be cautious and review their new contracts closely for these new hidden clauses. Physician contracts will likely follow with similar language.
Aetna is incorporating language on serious medical errors into its hospital contracts and will attempt to avoid paying for so-called “never events.”
These “never events” are 28 medical errors identified by the National Quality Forum that are so egregious to patient safety that they should never happen. Some of these include operating on the wrong body part, leaving a foreign object inside a patient after surgery or a patient death or disability associated with a fall.
Aetna’s newest template for hospital contracts mandates that hospitals report these “never events” to an accrediting agency within 10 days. Hospitals are then asked to take steps to ensure the error won’t be repeated, waive all costs related to the event and apologize to the affected patient and family members.
Aetna says it is the first health plan to endorse this approach to never events.
Since the CMS announced last fall it would halt reimbursements for some never events, payers such as the Blue Cross and Blue Shield Association have said they will follow suit.
Hospitals will need to be cautious and review their new contracts closely for these new hidden clauses. Physician contracts will likely follow with similar language.
posted by Anonymous at 6:08 AM
4 Comments:
Not sure what your point is. Exactly how is this avoiding paying?
If I go in to have my right leg amputated and the left one gets cut off instead, you're darn right that I expect the hospital and surgeon to "...waive all costs related to the event..."
Surely you don't think otherwise.
I certainly agree with the removal of the wrong body part, but some of the other 28 are not as blatant and not always able to be totally eliminated.
If you have forgotten, healthcare workers are still "human"
Pleading "human" is a bogus argument. We are all human. If you do not properly deliver the required service, payment should not be expected.
If my company does not deliver the correct product to a customer, that customer should not be expected to pay us for it. Even if the product was similar to what was ordered.
Granted, with my "grey" thinking, there probably are some "mistakes" that should be at least partially paid for.
I agree with Iamhoosier, Doctors and Hospitals should be held accountable for there errors. That is why they are able to charge upwards for $80. for3-5 min. of their time. Someone in my family went into a hospital for a muscle biopsy, after waiting weeks for the results, we had to finally take matters into our own hands to find out the results. The attending Doctor put us off, the hospital did the same. When we got the bills from Medicare and our supplement insurance, we found the pathologist name. We contacted her and found that the biopsy was not prepared and allowed to rot. The hospital sent it to University Hospital to see if they could salvage any of it. This entire episode cost Medicare and our Insurance almost $10,000.00. The response was don't worry about it Medicare will pay for it. So you can't blame insurance companies or Medicare. That is the mind set of a lot of healthcare providers. Its time that everyone make changes. Doctors and healthcare establishments included.
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