According to the National Quality Forum, there are 28 preventable errors providers make which result in serious consequences to their patients.  The NQF defines these events that should never happen as “adverse events that are serious, largely preventable, and of concern to both the public and health care providers for the purpose of public accountability.”  You can review a list of the events at http://psnet.ahrq.gov/primer.aspx?primerID=3.

Never events, and the associated bills, are handled differently depending upon the payor.  In 2008, CMS announced that they would not make payment for any of them.  In 2009, they went further and recommended that state Medicaid agencies follow the same rule.  Health insurance carriers have also attempted to institute the same restrictions through announced policies and began working the excluded never events into their provider contacts as a way to prevent the plan participant from being left holding the bag.  It comes as no surprise that patients were left with balance bills.

In the self-insured ERISA world, stop loss carriers have taken up the charge by informing their health plans that they simply will not provide reimbursement for never events.  However, unless the self-insured plan specifically excludes the events, the plan may be left responsible for payment.  And if the self-insured plan does in fact exclude the events, the member may be faced with unpaid bills.  It’s not as if a plan can advise their membership not to undergo such treatments as they are unplanned.  In the end, as is the case with anything that is not covered, the plan member may be responsible for payment and/or left with a fight against its Provider, including one for malpractice.