iLoveBenefits: Industry News Blog

After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know

Getting needed care is difficult by itself. Understanding what you will need to pay daunting. But making decisions about getting in network care is often well understood by patients. However, there are many care decisions that patients don’t make, are unable to make and are often made for them. This NYT article illuminates the practices that many patients encounter.

There needs to be public policy that sets forth the following: For an elective procedure, if a patient selects an in network hospital and an in network surgeon or primary care doctor then all other providers not selected by them must be handled, for insurance coverage purposes, as if they were in network as well…

“He was blindsided, though, by a bill of about $117,000 from an “assistant surgeon,” a Queens-based neurosurgeon whom Mr. Drier did not recall meeting.

. . .

In many other countries, such as Australia — where, as in the United States, people often rely on private insurance — it is seen as a patient’s right to be informed of out-of-pocket costs before hospitalization, said Mark Hall, a law professor at Wake Forest University.”

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