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NBC News
4 days ago
- Health
- NBC News
Patients allege that cosmetic surgeries led to disfiguring injuries
But a joint investigation by KFF Health News and NBC News found that Sono Bello and other cosmetic surgery chains have been the target of scores of medical malpractice and negligence lawsuits alleging disfiguring injuries — including 12 wrongful death cases filed over the past seven years. Injured patients have accused the chains of hiring doctors with minimal cosmetic surgery training, of failing to recognize and treat life-threatening infections and other dangerous surgical complications, and of high-pressure sales tactics that minimized safety risks, court records show. Sono Bello and the other companies have denied the allegations in court. 'These people promise to turn you into the fairest person in the land, and the risks aren't often worth the reality,' said Sean Domnick, a Florida attorney who heads the American Association for Justice, a trial lawyers group. Sono Bello's Centeno disagrees. He said the company's mission is to 'help each and every one of our patients live their best lives now.' Sono Bello offers 'life-changing transformations' that enhance a person's 'appearance as well as their quality of life,' said Centeno, a surgeon himself at the company's Troy, Michigan, office. The doctors who perform such surgeries, court records show, are sometimes paid more for taking on patients with a high body mass, as obesity raises the risk of devastating complications. And as the chains grow, there's little regulatory oversight. While the Food and Drug Administration maintains a database of complaints about drugs or medical devices, there's nothing similar for cosmetic surgeries. Schaeffer had liposuction at Sono Bello in January 2024 and was satisfied with the results. On the morning of March 29, 2024, she went in for more liposuction and a mini-tummy tuck that Sono Bello calls AbEX. The medical staff gave her Xanax, a tranquilizer and the painkiller oxycodone in pill form, according to medical records Sono Bello turned over to Schaeffer's attorney. During the procedure, she received an infusion of lidocaine to numb the area but remained awake. Sono Bello says the local anesthesia is safer and promotes faster healing with ' minimal discomfort,' so patients may return to work or other normal activities within a week. That didn't happen for Schaeffer, who said she felt so much pain during the operation that she began to cry and 'begged' the doctor to stop near the end. 'I said, 'I don't care what I look like,'' she said in an interview. ''I can't handle the pain.'' Two days later she spiked a fever, and a day after that her pubic area swelled up 'severely,' she said. Sono Bello medical staff told her that was normal and that she was fine, she said. Two days later, however, blood and fluid spilled out of her stomach when she got up, she said. On one visit to the office, Herrera told her she required surgery at a hospital to treat her wounds. But, she recounted, Herrera said he couldn't arrange that because he was an obstetrician, not a plastic surgeon, and didn't have hospital privileges locally. Herrera has hospital privileges in the Orlando area, about 140 miles southwest of Jacksonville. 'I was just in utter shock,' Schaeffer said. Sono Bello spokesperson Mark Firmani said the company does not require its doctors to have local hospital privileges, though many do have them. Centeno said Schaeffer's painful experience is not common. 'The reality is that over 90% of our patients who have our procedures completed are extremely comfortable during the procedure and they do quite well,' he said. Patients of Sono Bello and some other clinics also have complained to the Better Business Bureau of unexpectedly painful procedures. Centeno said that Herrera still works for the company, but the doctor's name does not appear on the company's Jacksonville website. Herrera runs an OB-GYN and aesthetics practice, which includes skin care treatments, in Winter Garden, Florida, near Orlando, and is board-certified by the American Board of Obstetrics & Gynecology. Sono Bello has considered him a rising star; Herrera's work in 2023 won Sono Bello's annual ' New Talent Award,' given to a company doctor who exhibits 'exceptional technical skills, productivity, and off-the-charts brand loyalty.' Herrera completed a Sono Bello fellowship program that teaches a 'suite of aesthetic procedures' in a six- to eight-week course under the direction of a company surgeon. The company says the fellowship offers 'patient-focused training in awake total body contouring and skin excision procedures.' Sono Bello allows physicians who have completed formal residencies in more than half a dozen types of surgery to apply for its fellowship. In a post on a Sono Bello website, Herrera said that before taking the fellowship course, he 'had been a skilled surgeon for over 13 years with extensive experience in other areas but limited knowledge on body sculpting.' Herrera did not respond to calls and emails requesting comment and directed Sono Bello to respond on his behalf. Company spokesperson Firmani said Herrera is still a member of the Sono Bello team. Many established plastic surgeons who spoke with KFF Health News and NBC News worry that chain surgery groups may be inclined to spend more effort on marketing and sales than on making sure their doctors are properly credentialed and capable of handling any complications that arise. Medical practices owned by private equity or investment firms have more money to spend drawing in patients, and 'the ability to operate and provide quality patient care is now less important,' said Mark Domanski, a plastic surgeon in northern Virginia. Doctor entrepreneurs Formed in 2008 by entrepreneurial physician Tom Garrison, Sono Bello now runs more than 100 centers nationwide. Private equity investors have pumped $816 million into the company, most of it since 2023, according to PitchBook, which tracks the industry. Sono Bello advertises widely on television and online, aimed at what one major investor termed the ' everyday woman and man.' It has advertised having '150+ board-certified surgeons who have performed over 300,000 laser lipo & body contouring procedures.' Sono Bello limits its offerings to services such as liposuction and its version of tummy tucks, which it believes its surgeons have mastered. It does not perform Brazilian butt lifts, or fat transfers, though many other cosmetic surgery chains do. While Sono Bello boasts that the vast majority of its patients are satisfied, court records show that allegations of substandard medical care have trailed its rapid growth. Sono Bello and its corporate affiliates and surgeons have defended more than 60 medical malpractice cases, including four suits involving patient deaths, since April 2013, court records show. Sono Bello has settled three of four wrongful death cases filed since May 2018, while one is pending, court records show. Schaeffer's suit in Jacksonville is among at least 19 filed since the start of March 2023. Many are pending in the courts, and the company has denied the allegations. Other physicians who have extended their brands to multiple cities and relied heavily on social media and splashy websites to bring in patients have also faced lawsuits. Mia Aesthetics, formed in 2017 by Texas surgeon Sergio Alvarez, runs a dozen cosmetic surgery clinics from Miami to Las Vegas. Mia Aesthetics provides 'the highest quality plastic surgery at affordable prices proving that being beautiful and saving money are two realities that can exist simultaneously,' its website says. Alvarez is a board-certified plastic surgeon. Patients filed at least 30 medical negligence cases against Mia Aesthetics and its affiliates from November 2020 through March of this year, court records show. A dozen suits target its Miami surgery center. The company has sought, and often won, dismissal of malpractice suits because patients signed contracts agreeing to arbitration of any disputes, court dockets show. Alvarez did not respond to requests for comment. Owned by New York physician Sergey Voskin since 2016, Goals Aesthetics and Plastic Surgery has branched out from a small cosmetic surgery office in the Brooklyn borough of New York City to a network of a dozen surgery centers it manages in eight states. Goals clinics and affiliated surgeons have been named as defendants in at least 40 malpractice suits filed from October 2018 through March, court records show. The Atlanta branch accounted for more than 20 such cases in Georgia courts from September 2022 through June 2024. Most are pending. Goals defended two lawsuits brought by the families of New York patients who died shortly after having liposuction procedures, court records show. Goals denied the allegations and won dismissal of some cases by invoking arbitration agreements, according to court dockets. The company says these agreements are commonly used throughout the medical industry. Voskin declined to be interviewed. In a statement, Goals lawyer Joshua Lurie said the medical offices it manages have performed more than 10,000 procedures and have 'one of, if not the highest track records of safety among similar types of medical practices.' Lurie said the 'vast majority' of malpractice claims are 'meritless.' These 'bad faith filings create an implication of risk when none exist and when, again, there is a very negligible negative outcome from surgery compared to the total procedures performed,' he wrote. No Guarantees Malpractice suits by themselves are not proof of wrongdoing. Nobody tracks the outcome of these lawsuits, which often are settled under confidential terms that keep key details out of public view and prohibit patients from discussing their experiences. Surgeons often argue that complications are a risk of surgery and that a poor outcome doesn't mean the doctor was negligent. To prove negligence, injured patients generally must show their care fell below what a reasonably prudent doctor with similar training would have done. That can be a challenge. Typically, the surgery chains fight back by arguing that complications are a risk of any surgical procedure and that they never guarantee results. Before their procedures, patients must sign consent forms acknowledging their expectations must be 'realistic' and that complications or dissatisfaction with the result does not necessarily mean the surgeon botched the job. The American Society of Plastic Surgeons investigates ethics complaints against its members, but not allegations of incompetence or malpractice. Some presurgery contracts allow for low-cost 'revisions' for disgruntled patients. Sono Bello has offered a 'satisfaction commitment,' which states: 'If your surgeon's evaluation determines your results to be deficient, we will touch up the area at no cost to you.' Other contracts contain disclaimers, such as reminding patients that dramatic 'before and after' photos widely shown in online advertisements and other solicitations may not reflect typical results. Demonstrating the influence of social media in driving sales, Goals once required patients to sign a nondisparagement clause. The contract stated that patients who bad-mouth the company on social media without first giving the company 'an opportunity to remedy any alleged issues' agree to pay damages of $10,000 for each violation. In a civil investigation of Goals' marketing tactics, Georgia Attorney General Chris Carr alleged that policy and others violated state consumer protection laws. In September 2022, Goals agreed to stop using the nondisparagement clause and to pay the state $119,480 to settle the matter, without admitting any wrongdoing. Both Goals and Mia Aesthetics have clauses in their service contracts that require arbitration of any disputes in lieu of court action, a process many consumer advocates believe favors the industry. These agreements are becoming more common among plastic surgeons. The arbitration clauses have prevented some aggrieved patients from getting their day in court. That happened in a wrongful death case filed by the family of Angela Mendez, 57, who was found dead in her apartment a day after liposuction at a Goals office in New York City in March 2021. She died from a pulmonary thromboembolism, a blood clot in her lung, as a complication of cosmetic surgery, according to an autopsy report. Her family sued the company alleging negligence. But in June 2024 a judge ruled that Mendez had signed a form requiring that the case be heard in arbitration and dismissed the lawsuit. Attorney Gary Zucker, who represents the family, is appealing. 'It's been a one-two punch for the family,' Zucker said. Goals attorney Lurie called arbitration 'a common practice throughout the industry and many industries' that is 'intended to speed the process to come to resolutions in a more expedited fashion.' In a 2023 deposition, Lurie said patients can opt out of the arbitration agreement, which 'has happened multiple times.' 'A Hard Sell' When Erin Schaeffer first visited Sono Bello, a sales agent told her she was a 'perfect candidate' for a tummy tuck procedure, she said in an interview with KFF Health News and NBC News. Though she wanted to think about it and talk it over with her family, she says the salesperson persuaded her to go ahead. Because cosmetic surgery is elective, insurance doesn't cover it. Schaeffer made a down payment and signed up for a credit plan through outside companies to repay most of the $19,838 bill over a five-year period, according to her medical records. She said she's now paying $420 a month. 'I definitely felt like it was a hard sell,' Schaeffer said. 'She didn't want me to leave out of there without putting money down on it.' Schaeffer said she didn't meet the doctor until about a week before the procedure, and only briefly. Some patients suing other companies have argued in court filings that they didn't meet the surgeon until the day of their operations, a practice that draws sharp criticism from more traditional surgeons. Scott Hollenbeck, president of the American Society of Plastic Surgeons, said patients need time with their doctor to fully understand the pros and cons of surgery and shouldn't be pressured into quick decisions. 'It is not possible to do that when you see the doctor an hour before surgery for the first time,' he said. 'You should have time to process what they told you, think about it, and make a decision.' 'That is best done with a surgeon, not a marketer,' Hollenbeck said. Good Candidates Many plastic surgeons discourage obese people from undergoing liposuction and other cosmetic procedures because of an elevated risk of infections and other serious medical complications. Candidates are considered obese at a body mass index of 30 or above. Sono Bello patients have an average BMI of 31, according to Centeno. At the time of her surgery, Schaeffer had a BMI of 36. But there's no consensus on who should be turned away because of their size — and policies vary. Sono Bello says its AbEX tummy tuck can be done safely with a body mass index as high as 42, well beyond the body mass limits for a traditional abdominoplasty done using general anesthesia. The AbEX removes loose and sagging skin around the stomach 'to achieve a more toned and sculpted look,' according to the company. Centeno said that high BMI 'does confer additional risk, which can be managed.' But he said it would be 'discriminatory, unethical and inappropriate for Sono Bello or any other medical practice to deny care to a patient based solely on their BMI.' Yet high-BMI patients have alleged they suffered devastating complications, according to KFF Health News' review of court cases filed against Sono Bello and other companies. One patient is Marissa Edwards, then 45, a California medical receptionist with three children. At 5 feet, 3 inches tall, she weighed 237 pounds, with a body mass index of 41. She had AbEX and liposuction at a Sono Bello clinic in San Diego on Oct. 11, 2022, according to court filings. During an office visit eight days later, she complained of swelling and pain in her abdomen, but a nurse 'dismissed her complaints,' according to the suit. On Nov. 4, Edwards noticed the incision was opening, while a rash formed around her belly button. In a text to Sono Bello, she attached a photo of her wound, which, the suit alleges, should have alerted the staff that it needed 'immediate evaluation by a qualified medical professional.' On Nov. 5, she woke up 'feeling extremely hot' and 'nearly fainted,' according to her complaint. Her husband drove her to an urgent care center, which diagnosed her with sepsis and rushed her to a hospital by ambulance. When she awoke the next morning, her bedsheets were soaked with body fluid. As she stood up, 'fluid began to pour out of her stomach and hit the floor,' according to the complaint. She spent six days in the hospital. Edwards alleges in her lawsuit that Sono Bello's medical staff failed to recognize and respond to early signs of trouble. 'I have sepsis and could have died,' she texted to Sono Bello's office line, according to court documents. 'I am very upset.' In one text that was included in her lawsuit, she wrote: 'So I would appreciate some type of empathy from you!! If you only knew what I have been through and you went through this I'm sure you wouldn't be giving me this snotty attitude.' Sono Bello denies any negligence. In a court filing, the company noted that infections are a risk of surgery, and that Edwards had signed a consent form that stated in part: 'The practice of medicine and surgery is not an exact science and results are not guaranteed.' Sono Bello filed a motion for summary judgment that argued her care was not negligent and 'not a substantial factor' in causing her alleged injuries. The case was settled earlier this month under confidential terms. Value Units While patients with high BMI are riskier, they also are more lucrative for Sono Bello surgeons, court records show. The company pays its surgeons for procedures based in part on the patient's BMI, using a formula it calls a 'surgical value unit.' The compensation plan surfaced in a lawsuit filed in December 2023 by Shirley Webb, then a 79-year-old Nevada woman. Hoping to slim down for a dream cruise, she paid $14,703 for an AbEX tummy tuck and liposuction of her stomach at the Sono Bello branch in Las Vegas. Eighteen days after her operation, she was 'oozing and bleeding' from her surgical wounds and her son rushed her to a hospital, where doctors diagnosed 'severe sepsis with shock,' according to the complaint. She spent several months in hospitals and rehabilitation care, running up medical bills of more than $2.6 million, her lawyer stated during a deposition. Lloyd Krieger, a California plastic surgeon who served as a medical expert for Webb's legal team, said the operations never should have happened because she was at 'very high risk for multiple procedures given her advanced age and high BMI,' according to the suit. In a court deposition, Sono Bello surgeon Charles Kim testified that operating on Webb earned him 'surgical value units' that boosted his pay to about $2,000 for the procedure. Sono Bello and Kim denied Webb's negligence claims and the parties settled the case in early 2025 under confidential terms, court records show. Centeno said Sono Bello surgeons are paid more for higher-BMI patients because they 'require additional work and additional complexity in terms of decision-making.' He added that 'our high-BMI patients routinely undergo our procedures safely with an extremely high patient satisfaction rate.' Schaeffer said people hoping to reshape their bodies need to do a lot of research before plunging ahead with plastic surgery. She said she was hoping to get rid of excess skin and fat after dropping 100 pounds. Instead, she missed seven weeks of work recovering from her tummy tuck in Jacksonville. 'I went into this procedure to try to make myself feel better after losing the weight, and I came out with something even worse,' she said. 'I trusted. I believed in what they told me, which I think most people do,' Schaeffer said. 'Not anymore.'
Yahoo
22-07-2025
- Health
- Yahoo
HIV prevention drugs are effective, but many who need them are left out
Despite highly effective HIV prevention drugs on the market, only a fraction of those at risk in the U.S. are taking them — or even know they're an option. It's called pre-exposure prophylaxis, or PrEP, and it is about 99% effective to prevent HIV infection through sexual contact when taken as prescribed. But only about one-third of the 1.2 million Americans who could benefit from the medication are taking it, according to an estimate from the Centers for Disease Control and Prevention. LaTonia Wilkins told CBS News she never knew PrEP was for people like her, even after she had an HIV scare. "I was dating a guy, and while we were dating, he found out that he was living with HIV," she said, adding that no one talked to her about the medication when she went to get tested. "At the time, I never even heard of PrEP," she said. She didn't start taking it until years later. "I thought PrEP was for gay men or trans women. I didn't know I could take PrEP." Who's at risk for HIV? More than 30,000 people in the U.S. are diagnosed with HIV — the virus that causes AIDS — every year in the U.S., according to the CDC, and a total of about 1.2 million are living with the infection. And it is not just a problem for any single community — almost a quarter of those infected get it through intimate heterosexual contact, the health agency estimates. Dr. Céline Gounder, a CBS News medical contributor and editor-at-large for public health at KFF Health News, says those considered to be at risk for HIV and who may want to get on PrEP include: People who are having unprotected sex AND who have a partner who has HIV;OR who have multiple sexual partners who have not been tested for HIV;OR who have had an STD in the last six among HIV prevention CDC data also shows a stunning disparity among people considered at risk for HIV. While 94% of White people who doctors say could benefit from it are now on PrEP, less than 13% of Black people and 24% of Hispanic/Latino people who could benefit are receiving it, and less than 15% of women at risk are getting the drug. Dázon Dixon Diallo founded a women's health advocacy group in Atlanta some 40 years ago because she saw Black women were being left behind in the fight against HIV. "I started Sister Love out of anger. Out of anger and frustration that nothing was happening," she told CBS News. Dixon Diallo and her team also stressed the need to normalize conversations about sex and HIV. "We want to acknowledge that people have sex, and that just like anything else that we engage in, there are risks," she says. PrEP prices and accessibility issues The cost of the PrEP medication, clinic visit and lab tests averages more than $5,000 a year, Gounder says. This creates accessibility challenges for people like Wilkins. "If my insurance provider decides, I don't want to cover this anymore, I really don't know what I would do because PrEP costs more than my rent right now," she says. "I have a lot of anxiety about that." A federal appeals court case could also limit insurance for PrEP, with some employers arguing they shouldn't have to pay for drugs that "facilitate behaviors ... contrary to" the employer's "sincere religious beliefs." "This federal court case could end insurance coverage or not require employers to provide insurance coverage for this. You also have Gilead — that's a company that makes these combination pills for PrEP — they're looking to narrow their patient assistance program by the end of 2024. And then on top of that, you have congressional Republicans who have proposed really deep cuts to funding for the CDC's HIV prevention program," Gounder explained on "CBS Mornings." What shocked "Matlock" star Kathy Bates? A new you: The science of redesigning your personality "Somebody Somewhere" star Bridget Everett Solve the daily Crossword
18-07-2025
- Health
Georgia shows rough road ahead for states as Medicaid work requirements loom
This is a KFF Health News story. Every time Ashton Alexander sees an ad for Georgia Pathways to Coverage, it feels like a "kick in the face." Alexander tried signing up for Pathways, the state's limited Medicaid expansion, multiple times and got denied each time, he said, even though he met the qualifying terms because he's a full-time student. Georgia is one of 10 states that haven't expanded Medicaid health coverage to a broader pool of low-income adults. Instead, it offers coverage to those who can prove they're working or completing 80 hours a month of other qualifying activities, like going to school or volunteering. And it is the only state currently doing so. "Why is this marketing out here?" said the 20-year-old, who lives in Conyers, east of Atlanta. "It's truly not accessible." Each denial used the same boilerplate language, Alexander said, and his calls to caseworkers were not returned. State offices couldn't connect him with caseworkers assigned to him from the same state agency. And when he requested contact information for a supervisor to appeal his denial, he said, the number rang to a fax machine. "It's impenetrable," Alexander said. "I've literally tried everything, and there's no way." Millions of Americans trying to access Medicaid benefits could soon find themselves navigating similar byzantine state systems and work rules. Legislation signed into law by President Donald Trump on July 4 allocates $200 million to help states that expanded Medicaid create systems by the end of next year to verify whether some enrollees are meeting the requirements. Conservative lawmakers have long argued that public benefits should go only to those actively working to get off of government assistance. But the nation's only Medicaid work requirement program shows they can be costly for states to run, frustrating for enrollees to navigate, and disruptive to other public benefit systems. Georgia's budget for marketing is nearly as much as it has spent on health benefits. Meanwhile, most enrollees under age 65 are already working or have a barrier that prevents them from doing so. What Georgia shows is "just how costly setting up these administrative systems of red tape can be," said Joan Alker, executive director of Georgetown University's Center for Children and Families. Over the past two years, KFF Health News has documented the issues riddling Georgia's Pathways program, launched in July 2023. More than 100,000 Georgians have applied to the program through March. Just over 8,000 were enrolled at the end of June, though about 300,000 would be eligible if the state fully expanded Medicaid under the terms of the Affordable Care Act. The program has cost more than $100 million, with only $26 million spent on health benefits and more than $20 million allocated to marketing contracts, according to a KFF Health News analysis of state reports. "That was truly a pretty shocking waste of taxpayer dollars," Alker said. The Government Accountability Office is investigating the costs of the program after a group of Democratic senators -- including both members of the Georgia delegation -- asked the government watchdog to look into the program. Findings are expected this fall. A state report to the federal government from March said Georgia couldn't effectively determine if applicants meet the qualifying activities criteria. The report also said the state hadn't suspended anyone for failing to work, a key philosophical pillar of the program. Meanwhile, as of March, more than 5,000 people were waiting to have their eligibility verified for Pathways. The Pathways program has strained Georgia's eligibility system for other public benefits, such as food stamps and cash assistance. In April, the state applied to the federal government to renew Pathways. In its application, officials scaled back key elements, such as the requirement that enrollees document work every month. Critics of the program also say the red tape doesn't help enrollees find jobs. "Georgia's experience shows that administrative complexity is the primary outcome, not job readiness," said Natalie Crawford, executive director of Georgia First, which advocates for fiscal responsibility and access to affordable health care. Despite the struggles, Garrison Douglas, a spokesperson for Georgia's Republican governor, Brian Kemp, defended the program. "Georgia Pathways is doing what it was designed to do: provide free healthcare coverage to low-income, able-bodied Georgians who are willing to engage in one of our many qualifying activities," he said in an emailed statement. New federal requirements in the tax and spending legislation mean that the 40 states (plus Washington, D.C.) that expanded Medicaid will need to prepare technology to process the documentation some Medicaid recipients will now have to regularly file. The federal law includes exemptions for people with disabilities, in addiction treatment, or caring for kids under 14, among others. The Trump administration said other states won't face a bumpy rollout like Georgia's. "We are fully confident that technology already exists that could enable all parties involved to implement work and community engagement requirements," said Mehmet Oz, head of the Centers for Medicare & Medicaid Services, in an emailed statement. In a written public comment on Georgia's application to extend the program, Yvonne Taylor of Austell detailed the difficulties she faced trying to enroll. She said she tried to sign up several times but that her application was not accepted. "Not once, not twice, but three times. With no response from customer service," she wrote in February. "So now I am without coverage." Victoria Helmly of Marietta wrote in a January comment that she and her family members take care of their dad, but the state law doesn't exempt caregivers of older adults. "Georgia should recognize their sacrifices by supporting them with health insurance," she wrote. "Let's simplify this system and in the end, save money and lives."
Miami Herald
14-07-2025
- Health
- Miami Herald
Insurers fight state laws restricting surprise ambulance bills
Nicole Silva's 4-year-old daughter was headed to a relative's house near the southern Colorado town of La Jara when a vehicle T-boned the car she was riding in. A cascade of ambulance rides ensued - a ground ambulance to a local hospital, an air ambulance to Denver, and another ground ambulance to Children's Hospital Colorado. Silva's daughter was on Medicaid, which was supposed to cover the cost of the ambulances. But one of the three ambulance companies, Northglenn Ambulance, a public company since acquired by a private one, sent Silva's bill to a debt collector. It was for $2,181.60, which grew to more than $3,000 with court fees and interest, court records show. The preschool teacher couldn't pay, and the collector garnished Silva's wages. "It put us so behind on bills - our house payment, electric, phone bills, food for the kids," said Silva, whose daughter recovered fully from the 2015 crash. "It took away from everything." Some state legislators are looking to curb bills like the one she received - surprise bills for ground ambulance rides. When an ambulance company charges more than an insurer is willing to pay, patients can be left with a big bill they probably had no choice in. States are trying to fill a gap left by the federal No Surprises Act, which covers air ambulances but not ground services, including ambulances that travel by road and water. This year, Utah and North Dakota joined 18 other states that have passed protections against surprise billing for such rides. Those protections often include setting a minimum for insurers to pay out if someone they cover needs a ride. But the sticking point is where to set that bar. Legislation in Colorado and Montana stalled this year because policymakers worried that forcing insurers to pay more would lead to higher health coverage costs for everyone. Surprise ambulance bills are one piece of a health care system that systematically saddles Americans with medical debt, straining their finances, preventing them from accessing care, and increasing racial disparities, as KFF Health News has reported. "If people are hesitating to call the ambulance because they're worried about putting a huge financial burden on their family, it means we're going to get stroke victims who don't get to the hospital on time," said Patricia Kelmar, who directs health care campaigns at PIRG, a national consumer advocacy group. "It means that person who's worried it might be a heart attack won't call." The No Surprises Act, signed into law by President Donald Trump in 2020, says that for most emergency services, patients can be billed for out-of-network care only for the same amount they would have been billed if it were in-network. Like doctors or hospitals, ambulance companies can contract with insurers, making them in-network. Those that don't remain out-of-network. But unlike when making an appointment with a doctor or planning a surgery, a patient generally can't choose the ambulance company that will respond to their 911 call. This means they can get hit with large out-of-network bills. Federal lawmakers punted on including ground ambulances, in part because of the variety of business models - from private companies to volunteer fire departments - and a lack of data on how much rides cost. Instead, Congress created an advisory committee that issued recommendations last year. Its overarching conclusion - that patients shouldn't be stuck in the crossfire between providers and payers - was not controversial or partisan. In Colorado, a measure aimed at expanding protections from surprise ambulance bills got a unanimous thumbs-up in both legislative chambers. Colorado had previously passed a law protecting people from surprise bills from private ambulance companies. This new measure was aimed at providing similar protections against bills from public ambulance services and for transfers between hospitals. "We knew it had bipartisan support, but there are some people that vote no on everything," said a pleasantly surprised Karen McCormick, a Democratic state representative. A less pleasant surprise came later, when Gov. Jared Polis, who is also a Democrat, vetoed it, citing the fear of rising premiums. States can do only so much on this issue, because state laws apply only to state-regulated health plans. That leaves out a lot of workers. According to a 2024 national survey by KFF, a health information nonprofit that includes KFF Health News, 63% of people who work for private employers and get health insurance through their jobs have self-funded plans, which aren't state-regulated. "It's why we need a federal ambulance protection law, even if we passed 50 state laws," Kelmar said. According to data from the Colorado secretary of state's office, the only lobbying groups registered as "opposing" the bill were Anthem and UnitedHealth Group, plus UnitedHealth subsidiaries Optum and UnitedHealthcare. As soon as the legislative session ended in May, Kevin McFatridge, executive director of the Colorado Association of Health Plans, a trade group representing health insurance companies in the state, sent a letter to the governor requesting a veto, with an estimate that the legislation would result in premiums rising 0.4%. The Colorado bill said local governments - such as cities, counties, or special districts - would set rates. "We are in a much better place by not having local entities set their own rates," McFatridge told KFF Health News. "That's almost like the fox managing the henhouse." Jack Hoadley, an emeritus research professor with Georgetown University's McCourt School of Public Policy, said it isn't clear whether state laws approved elsewhere are raising premiums, or if so by how much. Hoadley said Washington state is expected to come out with an impact analysis of its law in a couple of years. The national trade association for insurance companies declined to provide a comment for this article. Instead, AHIP forwarded letters that its leaders submitted to lawmakers in Ohio, West Virginia, and North Dakota this year opposing measures in each state to set base ambulance rates. AHIP leadership described the proposals as inflated, government-mandated pricing that would reduce insurers' chance to negotiate fair prices. Ultimately, the association warned, the proposed minimums would increase health care costs. In Montana, legislators were considering a minimum reimbursement for ground ambulances of 400% of what Medicare pays, or at a set local rate if one exists. The proposal was sponsored by two Republicans and backed by ambulance companies. Health insurers successfully lobbied against it, arguing that the price was too steep. Sarah Clerget, a lobbyist representing AHIP, told Montana lawmakers in a legislative hearing that it's already hard to get ambulance companies to go in-network with insurers, "because folks are going to need ambulance care regardless of whether their insurance company will cover it." She said the state's proposal would leave those paying for health coverage with the burden of the new price. "None of us like our insurance rates to move," Republican state Sen. Mark Noland said during a legislative meeting as a committee tabled the bill. He equated the proposed minimum to a mandate that could lead to people having to pay more for health coverage for an important but nonetheless niche service. Colorado's governor was similarly focused on premiums. Polis said in his veto letter that the legislation would have raised premiums between 73 cents and $2.15 per member per month. "I agree that filling this gap in enforcement is crucial to saving people money on health care," he wrote. "However, those cost savings are outweighed in my view by the premium increases." Isabel Cruz, policy director at the Colorado Consumer Health Initiative, which supported the bill, said that even if premiums did rise, Coloradans might be OK with the change. After all, she said, they'd be trading the threat of a big ambulance bill for the price of half a cup of coffee per month. Copyright (C) 2025, Tribune Content Agency, LLC. Portions copyrighted by the respective providers.
Yahoo
08-07-2025
- Health
- Yahoo
Doctors fear ICE agents in health facilities deter people from seeking care
As the Trump administration continues its push to undocumented immigrants, doctors are hearing that some patients are avoiding getting the health care they need over fears that Immigration and Customs Enforcement raids could take place in medical settings. Dr. Céline Gounder, CBS News medical contributor and editor-at-large for public health at KFF Health News, told "CBS Mornings Plus" on Tuesday that she has not seen any official ICE raids in hospitals, but that ICE agents have been seen in hospitals as well as other health care facilities. That's because detention standards require that ICE detainees be provided medical services, including initial medical and dental screenings, as well as emergency care. "They are often bringing in people that they've detained for medical clearance," said Gounder, who is also a practicing internist and infectious disease expert in New York City. "We see this often with law enforcement. But it is creating an atmosphere of fear. And my colleagues and I have had numerous patients tell us that they hesitated or waited too long to come in for health care." And delays in care matter, Gounder added. Delayed care for a heart attack or stroke, for example, can lead to more loss of heart or brain tissue. Gounder also heard from an emergency medicine physician in Los Angeles who has seen the impact of ICE agents appearing in hospital settings. The agents are arriving with ski masks and looking intimidating to the general patient, affecting the overall health of the community because it's creating an atmosphere of fear instead of of wellness, according to the doctor. The doctor also alleged agents have committed ethics violations, including not showing their identification, not allowing patient privacy during interviews and examinations, preventing doctors from contacting family for necessary medical information and preventing family from visiting. "These are really standard things," Gounder said. "Every patient should have the right to these kinds of provisions for good health care." "If you're a law enforcement official coming into a hospital or health care facility, you need to be identifying yourself as such, you need to be showing your badge or your ID," Gounder said, adding that those who want to enter private patient areas "also need to be showing a judicial warrant." Federal legal standards and privacy protections, including HIPAA and the 4th Amendment to the Constitution, bar unreasonable searches and seizures, including in non-public hospital areas. CBS News has reached out to ICE and the Department of Homeland Security for comment. A lot of health care providers don't know what their rights are, Gounder said, prompting at least some hospitals to offer employees guidance on potential ICE encounters. At Bellevue Hospital, for example, where Gounder works, staff were recently given sample prompts for interacting with non-local law enforcement, including ICE agents. The hospital told staff, in part: "We do not require a patient's immigration status to provide care, and we do not share medical or personal information about our patients unless required by law." The presence of ICE agents is not just a concern for physical health, but also mental health. "Think about who has come here as an immigrant, many of them have faced real trauma in their home countries," Gounder said. "So this, what feels like militarization of an emergency room, can be very re-traumatizing and cause some very relevant health impacts." Sneak peek: Who Killed Aileen Seiden in Room 15? Everything we know so far about the deadly Texas floods Search continues for dozens after Texas floods, at least 79 dead with more severe weather expected
