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 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 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.