The analysis of Peter
Drier’s neck surgery case raises a critical question about our medical bills.
From the article “After Surgery, Surprise
$117,000 Medical Bill From Doctor He didn’t know”, that patients may be
charged in full amount under a situation that any treatment procedures involved
out-of-network providers. This non-negotiable hefty fees, usually, is the
incentive that drives physicians to involve those providers. Although the
unexpected charges have become the major complaint from patients and health
insurance commissioners are trying to limit patients’ liability, unremitting
lobbies from health care industry hamper the efforts from insurers.
Furthermore, from the
article, the phenomenon can even take many forms. For example, it is not
uncommon that a surgery needs a fully trained assistant or a nurse, who would
not cause extra charge, but inform patients about extra services while they
were lying on bed in the operation room is not common. In Mr. Drier’s case, he
was billed of $117,000 by an “assistant surgeon” whom he did not recall meeting,
since he could not recognize all people in white outwears will be charged for
what kinds of services.
The out-of-network
rates drive unexpected medical costs. It would be astonishing that bills from
out-of-network services are much higher than in-network doctors. The figure
below may give readers some sense about their rates.
Sometimes insurers
have to pay the bills from the perspective of protecting their customers, and their
compromises encourage the phenomenon. Patients are just not in a good position
to bargain with hospitals, like Steve Brill wrote from his “$190,000 surgery”
that no one could consider economics or policies of health care while enduring their
pains and people just consider about the quality of health care they received.
Ultimately, most
people would be surprised about the bills after their surgery have been done.
One possible way to mitigate this phenomenon has been discussed in the follow
up article “Can a Computer Replace Your
Doctor?” Despite the present situation that people still run the healthcare
industry, the innovation of artificial intelligence and technologies will
re-shape our way to access medical care. I have learned, from these two
articles, that potential improvement of technologies might be a good way to
eludes “traditional” unexpected cases, but more importantly we need more
systematic regulations on our healthcare industry to make our bill
transparently. This crux is worth to discuss further in-depth in our class
through the semester.
Just to add a comment to clarify that out-of-network means the healthcare insurers are not recognized by those providers. Therefore, the bills from out-of-network providers will not be covered by insurance.
ReplyDeleteYour article has a small connection to my article about the rise of specialists incomes. In your case, Mr. Drier was billed $117,000 by an assistant surgeon he didn't remember meeting. This reminded me of how certain specialist doctors try to save money by having their assistant doctors or even nurse practitioners. It's interesting how unaware many patients are when entering a hospital or office. We want to meet the doctor right away (we think) but often someone else takes care of us entirely.
ReplyDeleteSee my post about an update to surprise medical bills. The NYTimes article was published in Sept., 2014. A lot has happened both before (in New York) and after (in California), and probably other states.
ReplyDelete