The New York Times recently reported an incident in which a patient was charged $117,000 by a surgeon he had never met before.
According to the article, in “an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees. They may be called in when the need for them is questionable. And patients usually do not realize they have been involved or are charging until the bill arrives.” Physicians or other medical professionals charge patients for care when their assistance or consulting is either not required or could be performed by someone who would bill a lesser fee or no fee at all.
Many times, the physicians are out-of-network, resulting in hefty bills. Insurance companies usually pay these costs without resisting in order to “protect their customer.”
Steps are being taken to reduce this unnecessary billing. 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 advance 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.”
The movement away from the fee-for-service model in healthcare and more transparent medical billing will also further eliminate the opportunity for the medical system to be exploited like this.
Summary By MedicalGroups.com
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