A person went into the hospital for a surgery on a herniated disk. He signed a bunch form set before him. Well, after the surgery, the bills started arriving. Bills in the range of $4,300 for the anesthesiologist, $56,000 from the hospital, and even $133,00 for his ortho doctor who he knew would take a fraction of that fee. However, a bill came from an assistant surgeon for $117,000! The patient did not remember ever meeting the assistant surgeon nor remember signing any forms pertaining to such. The patient felt he had absolutely no negotiating power and would be stuck w/ the bill. It is typical that doctors help each other with patient care. However, a new practice called “drive-by” doctoring is becoming more common. It is where assistants or consultants are charging patients or their insurers hefty fees, and the payer has little room to “know” if an assistant was really there or not. They may be called in to assist when the need is questionable at best. Patients are unaware until the bill arrives. These assistants may even be out of network providers charting 20 times the usual local doctor rates and collect the full amount. Insurers say this practice has gotten worse and are starting to file law suits fighting the charges and challenging them in court. However, lobbyists for the healthcare industry stymies their efforts. This practice contributes about $2.8 trillion dollars in annual healthcare costs.
Medical Billers Unexpected Charges
What can a patient do to assist in not having this happen? READ the paperwork before you sign it. ASK if consultants or assistant surgeons will be used and request that they be IN network. It may even be a good idea to write a letter to your doctor and surgeon and requesting the letter be put in your medical record to document that you did ask the right questions. An informed patient, is a smart patient.
With skyrocketing medical costs patients need to be more informed of what is going on with their healthcare. Possibly hiring a medical billing advocate BEFORE the surgery may be a good idea. They may be able to work with the hospital making it known that the patient is requesting ONLY in-network providers, and would like to be informed before any consultations or assistants are used so that they can verify the validity the of the need for such services. Whereas, the doctor knows best how to treat patients, it is a patients innate right to understand what is being done, why it's being done, and the projected costs. Doctors don't like to think of patients as “buying” healthcare services, but in fact, we truly are, and should have a say in how to limit expenses without compromising care.
By: Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC. Lives in the beautiful Southwest United States and has been an instructor for medical coding/billing for the past 7 years. Interested in quality medical billing training?