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sarahkliff's profile
Sarah Kliff
Sarah Kliff
Sarah Kliff
Verified account
@sarahkliff

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Sarah KliffVerified account

@sarahkliff

Senior Policy Correspondent @voxdotcom. Running a year-long project on emergency room billing. Help out by sharing your bill!

Washington, DC
erbills.vox.com
Joined January 2009

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    Sarah Kliff‏Verified account @sarahkliff May 23

    The newest story in my ER billing series: He went to an in-network emergency room. He still ended up with a $7,924 bill. Diving into the high frequency of out-of-network billing at in-network ERs.https://www.vox.com/2018/5/23/17353284/emergency-room-doctor-out-of-network …

    4:10 AM - 23 May 2018
    • 96 Retweets
    • 149 Likes
    • Patsy Writesman Emily Colyer ACP MA Governor - Dr. Elisa Choi, MD, FACP tufted turdmouse Suzanne Delbanco Barbara Wray Dheeraj Raina, MD President Camacho 🌐&🌹 Anonymous Doctor
    27 replies 96 retweets 149 likes
      1. New conversation
      2. Jeremiah Schuur, MD‏ @JSchuurMD May 23
        Replying to @sarahkliff

        Title misses “from an out of network oral surgeon”

        3 replies 0 retweets 13 likes
      3. Kelly Doran‏ @KellyMDoran May 23
        Replying to @JSchuurMD @sarahkliff

        From the article: “surprise bills are the most common in ER visits where the patient is ultimately admitted to the hospital for further treatment...often from specialists...” So why frame as “ER” problem vs “hospital” or “specialist” problem? Headlines are important.

        1 reply 0 retweets 6 likes
      4. Sarah Kliff‏Verified account @sarahkliff May 23
        Replying to @KellyMDoran @JSchuurMD

        Morning! I think it's fair to use ER in the headline because that is the site where the patients I'm writing about are receiving care. As I note in the article, 14 percent of ER patients who remain outpatient also face out-of-network bills.

        8 replies 0 retweets 12 likes
      5. Kelly Doran‏ @KellyMDoran May 23
        Replying to @sarahkliff @JSchuurMD

        Thanks for replying! Of the 14% who were discharged from ED, do you know for what % the surprise bills came from specialist consults vs. ED docs? That would be helpful to know re: how to frame and how to best address the problem (re-replying, typo in my 1st!)

        2 replies 0 retweets 2 likes
      6. Sarah Kliff‏Verified account @sarahkliff May 23
        Replying to @KellyMDoran @JSchuurMD

        This is from the Garmon study I cite in the piece, which unfortunately doesn't have that level of specificity. It's here: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.0970 … This separate report from TX suggests its a problem that spreads across ED docs/specialists https://forabettertexas.org/surprisebills/img/2017_HW_SurpriseMedBill.pdf …

        1 reply 0 retweets 3 likes
      7. Sarah Kliff‏Verified account @sarahkliff May 23
        Replying to @sarahkliff @KellyMDoran @JSchuurMD

        Separately, I think @zackcooperYale's research on ER staffing suggests that this is a challenge that spreads pretty widely across different types of physicians working in ERs.https://www.nytimes.com/2017/07/24/upshot/the-company-behind-many-surprise-emergency-room-bills.html …

        2 replies 1 retweet 3 likes
      8. Kelly Doran‏ @KellyMDoran May 23
        Replying to @sarahkliff @JSchuurMD @zackcooperYale

        Thanks, saw that one! Definitely some bad actors and seems like a multi-factorial problem. Here’s why I worry about ER-focused framing BTW: 1) ERs already demonized in health care, has led to misguided policy efforts & more, and...

        1 reply 1 retweet 3 likes
      9. Kelly Doran‏ @KellyMDoran May 23
        Replying to @KellyMDoran @sarahkliff and

        2) People already scared to go to ER due to $ and I would hate to see even more avoiding ER care they need (yes, we—the entire health care and political system—really need to fix it so people aren’t afraid of bankruptcy from needed medical care)

        1 reply 1 retweet 8 likes
      10. 4 more replies
      1. New conversation
      2. Steve Carroll DO MEd‏ @embasic May 23
        Replying to @sarahkliff

        Com’on Sarah- this is not an ER issue- oral surgeons are not employed by the ER- this is an “out of network surgeon issue”- please write better headlines that don’t deceive readers

        2 replies 2 retweets 18 likes
      3. Sarah Kliff‏Verified account @sarahkliff May 23
        Replying to @embasic

        It's an ER issue because these out-of-network surgeons are working at in-network ERs.

        3 replies 2 retweets 13 likes
      4. SpaceMan Spiff‏ @movinmeat May 23
        Replying to @sarahkliff @embasic

        The surgeon works in the hospital. Not the ER. Surgeries take place in the OR. Different site.

        1 reply 0 retweets 6 likes
      5. Sarah Kliff‏Verified account @sarahkliff May 23
        Replying to @movinmeat @embasic

        Fair enough, but I think from the patient perspective this looks pretty different. The surgeon comes into the ER, consults with the patient there. He is working in and seeing patients in the ER.

        2 replies 1 retweet 9 likes
      6. SpaceMan Spiff‏ @movinmeat May 23
        Replying to @sarahkliff @embasic

        If anything this illustrates the difficulty in maintaining an ER call roster. Most oral surgeons work out of offices/surgicenters. They don’t have to (and many don’t!) take ER call. Same applies to ENT, Optho, Plastics, many other specialties 1/x

        2 replies 1 retweet 3 likes
      7. SpaceMan Spiff‏ @movinmeat May 23
        Replying to @movinmeat @sarahkliff @embasic

        Many hospitals frequently have big gaps in their call roster, and this is one of the reasons: they have to deal w insurance nonpayment (in addition to many other hassles).

        0 replies 1 retweet 2 likes
      8. End of conversation
      1. Ken Shanahan‏ @kenpshanahan May 23
        Replying to @sarahkliff

        This should become illegal, absolutely crazy for a patient to check every aspect of their care. If this continues it will be difficult to provide care

        0 replies 2 retweets 8 likes
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      1. New conversation
      2. Sarah McManus‏ @OohShiny_Sarah May 23
        Replying to @sarahkliff

        Incredibly common. My insurance company’s advice, when my 6 mo. old went in for life saving brain surgery, was “Ask if the anesthesiologist is in network.” Docs stopped the cart into the MRI room when I asked. “Do you want us to check? Now?”

        1 reply 0 retweets 11 likes
      3. Sadie LaPonsie, MD‏ @DoctorSadieL May 23
        Replying to @OohShiny_Sarah @sarahkliff

        And what are you supposed to do if they’re not?!

        1 reply 0 retweets 3 likes
      4. 1 more reply
      1. LetsTalkThroughThis‏ @LetsThrough May 23
        Replying to @sarahkliff

        Thank you for writing this important piece. Do you believe consumers should put pressure on companies like @Humana, (~63% of TX hospitals having ZERO in network docs w Humana) or gov for not supporting ACA (so insurance can afford to be in TX) or hospitals or something else?

        0 replies 1 retweet 4 likes
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      1. Anita Ruff‏ @AnitaRuff May 23
        Replying to @sarahkliff

        It’s a sign of how messed up things are when my first thought was, “$7,924? That’s pretty good.”

        0 replies 0 retweets 6 likes
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