Their vice-president of government affairs is Milla Perry Jones, Gov. Rick Perry's sister.
When I am a CEO, if I ever find out that one of my employees is the sister of the sitting Governor of the state which I do all business in, remind me to make her my company's VP of Government Affairs.
You should probably find out whether she gets along with her sibling first.
I think it depends how much profit there could be in abortions. Federal programs don't cover them, most commercial insurance I think doesn't, and the people getting them have limited out-of-pocket means (possibly lower-income than the average person getting surgical procedures, at least in being younger). That limits the likelihood of this idea, I think.
Ambulatory surgical centers, while a not-bad idea at the inception (do simpler surgeries in a less costly setting than hospitals), in practice became a way to bump up the volume of these procedures, with physicians normally being part-owners and referring out from their own practices or hospitals.
There was recently a fascinating-to-me lawsuit in which Aetna sued a group of ASCs in the South Bay for cherry-picking people with particularly generous plans, getting them to come to their centers which were not contracted with the plan, waiving the patient's 20% or 30% coinsurance for out-of-network services, and sending the remainder of gross charges - the good old chargemaster - to the insurer. Customarily insurers pay some percentage of gross charges if there's no contract, but the forehead-slapping part is that Aetna apparently didn't have the competence to realize these places' gross charges were five to ten times higher than normal before cutting the checks. One day it blinked and realized it was out several million dollars.
Actually, as I do more research, I wonder how much of the rise of ASCs is due to the service type being an exception to the Stark Law against self-referrals to operations in which the physician has a financial interest.
I am not sure this is relevant, since these centers wouldn't be doing third trimester abortions. But there are only two places in the country that do them now. April 2012, one was willing to do our 32 week labor and delivery for $32,000. The other was closer to $25,000, again for stopping the baby's heart, inducing and delivering the baby. The patient pays the full amount up front and hassles with their own insurance later. (In the end, we didn't pay that, because they wouldn't deliver a baby with the head diameter ours had. They charged us $8000 for the shot that stopped the baby's heart. Then we flew home and delivered at our regular hospital.) The other women on the forums report paying tens of thousands of dollars.
I am willing to believe that it could be very lucrative.
3.last is surprising. I thought that for out of network it was usually X% of the "reasonable and customary" fee regardless of what's charged, not X% of the actual fee.
6: Yeah, I was simplifying. I think they were using a percentage of gross charges as a proxy for UCR in this case, and even though they must have lots of experience as to what's reasonable and what they normally pay, they still cut these huge checks.
Insurance companies tend to spend a lot of time playing catch-up with medical providers and their elaborate insurance-fraud schemes. Its all part of having the Greatest Health Care System in the World.
most commercial insurance I think doesn't
That surprises me. When it came up, my insurance covered it like pretty much anything else.
Oh, maybe not. I remember hearing about having to get riders? But that may be due to certain states' laws.
8: This one doesn't seem that elaborate to me. Unless they had someone on the inside approving the claims. (And it was in-network doctors referring to their out-of-network ASCs.)
Unless they had someone on the inside approving the claims.
Given how much of the process is automated, it could also be "unless the code to detect and prevent that hadn't been written into the software yet."
Nearly everything you've shared about your situation has been heartbreaking, anon, but 5.parenthetical is just brutal. Christ.