EP290: Shining a Light on the Crafty Gambits Used by Some (Not All) Hospital Billing Departments, With Doug Aldeen

In this Episode 290, Stacey Richter talks with Doug Aldeen, a health care and ERISA attorney, about the crafty gambits some (not all) hospital billing departments have used during COVID-19.

WHAT YOU'LL LEARN

✅ Why exploitive billing practices tend to show up when a hospital's mission statement and its finance team are on two different planets

✅ What a hospital's "scorched earth" billing policy looks like and who it can hurt

✅ Why hospital-owned insurance plans, or "payviders," create their own set of exploitive billing risks

✅ How reference-based pricing (RBP) works and where it fits into the fight over fair pricing

✅ Why educating employees on what care actually costs is a critical part of the solution

WHY THIS MATTERS

Doug Aldeen has spent two decades negotiating with hospital finance teams on behalf of self-insured employers, and he lays out the gap between what hospitals say their mission is and how their billing departments actually behave — especially during COVID, when some hospitals leaned harder into aggressive billing tactics even as they were being financially squeezed by the pandemic. From scorched-earth collection policies to payvider conflicts of interest to reference-based pricing disputes, Aldeen walks through the mechanics employers and patients need to understand, plus what it actually takes to push back.

MENTIONED IN THIS EPISODE

🔗 EP242, with Marty Makary, MD

🔗 EP186, with David Contorno

🔗 EP240, with Olivia Ross

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

03:59 Exploitive hospital billing practices.

04:20 The impact these exploitive billing practices have on patients.

04:45 Why would a hospital exploit the patient with their billing practices?

09:31 "You could adversely affect 3 million people."

10:53 The "scorched earth" policy.

11:33 EP242 with Marty Makary, MD.

12:28 "I think the long-term plan … is preserving the network."

13:08 EP186 with David Contorno.

16:03 A third exploitive billing process: hospital-owned insurance plans, or "payviders."

20:35 MOOP: maximum out of pocket.

21:07 RBP: reference-based pricing.

21:58 Exploitive tactic #4.

26:03 The solution to changing exploitive billing strategies.

26:39 "You have to be willing to travel."

28:34 EP240 with Olivia Ross.

28:47 "It's educating your employees and really having an honest conversation about 'This is what it really costs.'"

30:28 Doug's advice to hospital execs listening right now.