Physicians Group Opposes Fair Medical Billing

There’s a bill in the North Carolina Legislature that seeks to eliminate some surprise medical billing, among other things. Here’s a real-world example from Cumberland County:

Yours truly found himself with an exceptionally bad intestinal bug a few years ago. I then found myself in the Cape Fear Valley Hoke Emergency Room. I figured Hoke would have a shorter line. After I was admitted, a staff member rolled a fancy computer with a credit card scanner beside my bed. She took my insurance info and showed me what me what it would cost out-of-pocket. I paid before anyone would see me. It wasn’t cheap. They gave me IV fluids and ran some labs.

A few weeks later, I got a bill from the lab technician for several hundred dollars. I called Cape Fear and told them I already paid for everything. Cape Fear’s response was that their lab was “in-network” but the person who actually worked in the lab was not. He was special, apparently.

I was pretty upset, but I paid it anyways.

I think a lot of people do.

Most of you have probably faced the maze of medical billing at some point in your life. It’s insane. I deal with it every day in my legal practice, and I’m often frustrated by the amount of waste and deception that is involved. This provision is a step in the right direction:

All contracts or agreements for participation as an in-network health service facility between an insurer offering health benefit plans in this State and a health service facility at which there are out-of-network providers who may be part of the provision of services to an insured while receiving care at the health service facility shall require that the in-network health service facility give at least 72 hours’ advanced written notification to an insured that has scheduled an appointment at that health service facility of the provision of any services by an out-of-network provider to the insured while at that health service facility. If there are not at least 72 hours between the scheduling of the appointment and the appointment, then the in-network health service facility is required to give written notice to the insured on the day the appointment is scheduled. In the case of emergency services, the health service facility is required to give written notice to the insured as soon as reasonably possible. The written notice required by this subsection shall include all of the following:

(1) All of the health care providers that will be rendering services to the insured that are not participating as in-network health care providers in the applicable insurer’s network.
(2) The estimated cost to the insured of the services being rendered by the out-of-network providers identified in subdivision (1) of this subsection.

Click to access H149v3.pdf

Doctors Oppose Patient Protections

The North Carolina Medical Society, a special interest group representing physicians, opposes this reform. Per Paul Woolverton at the Fayetteville Observer:

The Medical Society has concerns about this provision, Baggett said.

“We’d like to see an end to surprise billing also,” he said, but doctors worry that when they see the cost, some patients may forgo care that they need. The Society wants to work with the legislature to find another solution to surprise billing, he said.

https://www.fayobserver.com/story/news/2022/06/01/medicaid-expansion-healthcare-north-carolina-medicaid-con-certificate-of-need/9914529002/

The arrogance of physicians (and their lobbyists) in this case is baffling.

When people can’t afford the cost of a service, they don’t usually ask for it. You don’t get to trick them into accepting your service by hiding the cost up front. In any other instance in our society, we would simply call this “fraud.”

Apparently, the physicians and their lobbyists prefer the current way we do things: don’t tell people what it’s going to cost and send them a bill later. If they don’t pay it, send them to collections and wreck their credit score.

It’s awful, and it ruins people’s faith in our health care system.

Fix it.

Primary Kool-Aid

In the early years of marriage, the store bought taco kit became a weekly staple. Old El Paso was the go-to, until Taco Bell came out with a kit that included a pack of Tropical Punch Kool-Aid:

Like a kid wanting a box of cereal for the toy inside, 20-something me bought these kits specifically for the Kool-Aid. I could have just bought the Kool-Aid for like 25 cents back then, but it seemed better this way. I’d mix it up merrily as Mrs. Richardson rolled her eyes.

It should come with a warning. It stained every pitcher we had. Somehow the red dye would permeate the plastic. If you got any on the carpet, you were done.

I did…

It cost us the security deposit on our Buies Creek apartment.

Partisan Dye

The partisan litmus test got out of control in 2022. For months, we’ve had every single candidate trying to out-red or out-blue the other.

Every day we get flyers from Val Applewhite featuring a picture of Donald Trump that tells us Kirk deViere is “not a real Democrat.” He is.

Every day I hear a radio ad claiming Bo Hines is “not a real Republican.” He is.

It’s absurd, and it’s not going to solve a single problem facing our country. But it gives us a quick sugar rush and makes us feel good, so we keep buying it.

The price we pay is an erosion of faith in our institutions and distrust in our fellow man. Good ideas and the compromise needed to implement them are stifled. There’s no room. Instead, millions are spent on ads convincing you to fight the other side with politically-pure partisan warriors.

In the end, we can’t all be right, all the time, but we keep drinking the Kool-Aid.

Then it stains who we are.

Undefined

The stock market is tanking, interest rates are rising, and a value meal at McDonalds will run you ten bucks if you get an apple pie. The post-covid world is not as pretty as we imagined.

From the yard signs scattered about town, you probably know we have an election coming up in a few days. Do you care? Is there an issue that has you motivated to vote in this primary?

We should be talking about a lot in politics right now, because decisions are being made that will shape our short-term future. Instead, it seems the world is looking ahead, trying to find some solace of normalcy.

In the midst of uncertainty, politicians like to sit and wait. This seems to be the case from City Hall to Congress. Everyone’s waiting to see how it shapes up.

Missed Opportunity

There’s a problem with the wait and see approach. A lot of these primary races are crowded. There’s eleven Democrats and fourteen Republicans running for one U.S. Senate seat in North Carolina. There’s six people running for Mayor of Fayetteville. Most City Council races have multiple candidates.

When you’re in a crowd, you’ve got to stand out. You stand out by standing for something. Say what you want about Trump, but that’s how he got through the Republican field in 2016, and he wasn’t nice about it. He defined himself and his opponents with vicious clarity.

I know we’ll get back to torching one another as soon as the primary is over. Then it’ll be all-out partisan warfare going into the midterm elections.

I’ll leave you with this: Voting starts in 48 hours and the leading story in the news is Madison Crawthorn accidentally bringing a gun into the Charlotte airport.

That’s where we are.

Where are we going? I have no idea.


Nash County Spite (Cooper and deViere)

When I was a student at UNC, I had a buddy from Nash County. One evening, he noticed a Ducks Unlimited print on my apartment wall and the conversation turned to hunting. He bragged about killing twenty wood ducks one morning a few years back in a beaver swamp near his home.

“You can only kill two.” I replied.

I can still hear his slow, deep, drawl:

“We just kept shooting them.”

It upset me, but I left it there. You either respect the game (laws), or you don’t. He didn’t.


Governor Roy Cooper likes to tout his roots. If you’ve followed North Carolina politics during his two-term reign, you’ve probably heard the story about his watermelon patch or the one about him blocking Phil Ford’s shot in a high school game. Southern, white Democrats are a dying breed, and Cooper’s “one of us” appeal allows him to steal enough Independent and Republican votes to stay in power.

If you grew up in the Eastern part of the state like he did, you’ll notice that there’s a little bit of spite in the people, fire and brimstone even, that bites sharper than the apple cider vinegar we put on our pork. You can trace it back to the Revolution. We came here to be left alone and then stayed put. The farther east you drive on 64 or 70, the deeper it gets. We’ve got a mean streak if you push us too far. Shut your mouth and play along, and we’ll get along just fine.

Fight that mean streak, and you’ll elect Terry Sanford.

Foster that mean streak, and you’ll elect Jesse Helms.

Temper that mean streak, and you’ll elect Roy Cooper and Donald Trump in the same election.

Democratic Senators and Cumberland County

Tony Rand represented Cumberland County in the North Carolina Senate from 1981 to 2009, becoming one of the most powerful men in the state in the process. After his retirement, Margaret Dickson took the seat. She was defeated in the next election by Republican Wesley Meredith in a vicious campaign that made national news.

Meredith got the backing of the Republican Party and developed a massive war chest. He won four elections in a row. I had a front row seat to one of them in 2014. Meredith and the Republican attack machine ran ads on the 5:00 news claiming my old man “had no moral compass.” Another ad played horror music, showed an empty baby crib, and claimed my dad got a child killer off. I had a son in a crib at the time.

Then came Kirk deViere.

Meredith lost two elections in a row.

Meredith has filed to run against deViere again this year.

This week, in a head-scratcher, Cooper endorsed deViere’s Democratic opponent.

Sunken Ambitions

Cooper has been in politics since 1986, and it’s fairly unlikely that he wants to go back to Nash County after having the best seats in the Dean Dome for the past eight years. He’s going to make a run at the Vice Presidency (if Harris continues to flounder), the Presidency (if Biden’s health gives out), or the U.S. Senate.

In order to get to the next level, Cooper needed to be more than another Tim Kaine. He needed something to set him apart. He had his sights on two issues: Covid and Medicaid expansion.

N.C.’s Covid response started off well enough. We were doing better than the rest of the South due to our increased restrictions. Then the reality of extremely contagious respiratory diseases set in and we quickly ended up as bad as everyone else. None of it was worth it. Our school kids will continue to suffer the ramifications of Cooper’s leadership, and Republicans are foaming at the mouth to remind swing voters who closed the businesses and schools across the country.

Medicaid expansion quickly became all Cooper had left. He wanted to use the power of his veto pen to force Medicaid expansion into the state budget. He needed unanimous (or close to it) Democratic support in the legislature to get it.

DeViere and a group of moderate Democrats worked with Republicans to get a budget passed. In doing so, they did very, very well for their constituents back home. Cooper signed the budget, but it wasn’t what he wanted.

So what happens when a lame duck Governor from Nash County gets angry?

“It’s my birthday, it’s my birthday,” Applewhite sang happily during a phone call Tuesday to talk about the endorsement. She turns 61 on Saturday, she said.

“It’s huge,” she said. “It’s unusual for a governor to engage in a primary.”

“I think it’s two things. It’s his confidence in who I am, and the issues of Medicaid expansion, paying our teachers — these are clear, no-brainer issues. But what’s more important is that it shows (Cooper’s) lack of support for our current senator.”

https://www.fayobserver.com/story/news/2022/03/09/gov-roy-cooper-north-carolina-endorses-cumberland-county-senate-kirk-deviere-val-applewhite/9425289002/

What it Means

It’s all personal and petty with a touch of spite. More importantly, it’s bad politics.

Cooper beat Republican Dan Forest in 2020 with only 51.5% of the vote. He didn’t get a resounding mandate for a liberal agenda. If North Carolina Democrats want to regain control, they’re going to have to win swing districts like deViere’s. More importantly, they are increasingly becoming an urban, minority party, out of touch with half of the State. DeViere brought together a coalition of voters and beat the Republican machine, twice. Cooper doesn’t seem concerned with that. In the end, he only seems concerned with himself. Maybe eight years in a mansion does that to someone? Regardless, it might be time to re-learn an old lesson from a Nash County beaver swamp:

You kill all your good ducks, and you can’t go hunting next year.

Kirk, Clarence, Val…and Wesley

Not much has changed in two years.

There’s still a chain link fence around the Market House, and Kirk deViere has some work to do to keep his N.C. Senate seat.

Former District Court Judge, Clarence “Ed” Donaldson, and former City Council member, Val Applewhite have filed to run against deViere in the upcoming Democratic primary.

Donaldson lost to deViere in the 2018 Democratic primary, running under his given name “Clarence”:

Donaldson will appear on the ballot as “Ed” this time around. Fool me once?


The winner of the Democratic primary is likely to face Wesley Meredith (R), who also filed this week.

Meredith has been longing for his old seat for the past four years. He’s lost to deViere twice now, but perhaps Meredith believes that a nation-wide Republican surge in response to the floundering Biden Administration will give him an advantage in 2022. He may be right.

This is a good time to remind folks that in 2018, I predicted the result of the Meredith/deViere race within a few hundredths of a percentage point:

Might be time to get the calculator out again.