We’ve all been to the doctor and signed a myriad of consent forms. Unfortunately, they are still shaped like a TOS for a credit card. Most of the time, you have no clue what you are signing, and in the case of Peter Drier, you are depending on the doctors to look after your best interest.
The New York City resident had researched his insurance and understood he was in for some hefty medical bills, but knew the doctors he met would accept a fraction of the medical bill. $56,000 from the Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and $133,000 from the orthopedist who was performing the three-hour neck surgery.
His herniated cervical discs had to be repaired, and he had an understanding that the $133,000 would be whittled down to a fraction of what the bill laid out.
Then came the bill that blindsided him. A $117,000 bill from an assistant neurosurgeon that Peter never met. How comforting. Every surgery I’ve had, I have met everyone before going in. This is beyond disconcerting that an assistant neurosurgeon effectively ‘drives-by’ and assists on a patient they never met.
The main problem with this, is you have doctors performing on patients without prior consent. It isn’t unusual for doctors to bring in outside help, but the reasoning is clear. Money. These doctors are primarily out of network. That equals an incredible amount of charges. Up to 40 times what an in-network doctor can charge.
Notice the assistants fee is nearly that of the orthopedist? That’s no accident. It is an end around of the current health insurance landscape. The Affordable Care Act is turning out to be not so affordable if you accidentally go out-of-network. The drive-by doctoring is contributing to the $2.8 trillion in nation’s health costs.
The rash of out-of-network charges has caused insurance companies to take up cases of patients. You know it’s bad when an insurance company is calling foul.
The issue? Financial concerns. That’s the new age way of saying lobbyists are halting any fixes in the system. The ACA may have opened up insurance to more patients, but it also closed off numerous paths to care for patients. Increased premiums and less care, what’s not to love?
Currently, there are no laws on the books to force hospitals to join an in-network system to provide doctors, labs and other diagnostic tests. In Mr. Drier’s case, he complained to Aetna, his provider. The insurance company agreed that it wasn’t his responsibility, but still cut the check to the assistant.
All this does is encourage the practice. It isn’t just surgeries. Many ERs now are staffed by contractors who bill separately. So you roll into the ER for an emergency and it turns out you have a line of contractors who are going to load you down with medical bills.
How to fix the system? The Affordable Care Act needs safeguards in place to prevent this type of abuse. Patients have rights, and this is a blatant attempt at a money grab. Like all government programs, people are always looking for a way to skirt the law to line their pockets. It’s not only dangerous, but wildly unethical.
Read the full piece at the New York Times.