The New York Times has a great article about how hospital secretly use out-of-network providers to screw over patients in which they describe a surprise $117,000 bill for an “assistant surgeon.” From the NYT:
In Mr. Drier’s case, the primary surgeon, Dr. Nathaniel L. Tindel, had said he would accept a negotiated fee determined through Mr. Drier’s insurance company, which ended up being about $6,200. (Mr. Drier had to pay $3,000 of that to meet his deductible.) But the assistant, Dr. Harrison T. Mu, was out of network and sent the $117,000 bill. Insurance experts say surgeons and assistants sometimes share proceeds from operations, but Dr. Tindel’s office says he and Dr. Mu do not. Dr. Mu’s office did not respond to requests for comment. […]
A New York State law that will take effect in March — one of a few nationally — will offer some protection against many surprise charges and require more advanced disclosure from doctors and hospitals on whether their services are covered by insurance. It states, for example, that patients are not responsible for unforeseen out-of-network charges beyond what they would have paid in-network. It directs insurers and hospitals to negotiate any further payment or enter mediation.
This story illustrates two important points. The first is it shows how idiotic the concept of consumer-driven medicine really is. Here is a man who aggressively tried to shop around but the hospital, which has way more power and knowledge, was able to bring in a surprise out-of-network doctor while they guy was unconscious. Smart shopping around for health care would be hard enough given its complexity even if every provider was an angel. It is impossible when the system is actively trying to screw people.
It also sadly highlights how terribly the health care industry has corrupted our politicians because this problem is so easily solvable. Every other health care system which uses private insurers has some all-payer function to set reasonable prices for procedures. It should be criminal for anyone to try to charge $100,000 for an hour of work. If American politicians really wanted to fix this and many other problems they would have the solution after a 10 minute phone call with any of the health secretaries from a dozen other countries.
Instead all we get is whac-a-mole solution in New York that hospitals will find a way around.