Lately, an article from the New York Times about surprise medical charges has been making the rounds on Facebook. Once again people are taking the article at face value without doing any further research. Luckily for you, I’m here to tell you the real deal as I call upon my 20+ years experience in the healthcare field. If you doubt my credentials they just happen to be that I worked for a major health insurance company for ten years and for the next 15 I’ve been working in various medical clerical positions mostly including medical billing.
The article seems to be mostly focused on one man’s plight when he received a rather astronomical bill for a surgery that he had. The charge was for an assistant surgeon who was out of his insurance’s network. The article gives the impression that there is no recourse even though there is.
First off this is a rare occurrence in my experience. If you going to have surgery in a hospital that is in your network and the primary surgeon is in your network then the odds are that the assistant surgeon will be in your network too. If the assistant surgeon is not in your network a majority of the time the insurance company is willing to make a deal with the doctor and most doctor’s offices are more than willing to work with the insurance company. The article also seems to give the impression that doctors will know ahead of time if they’ll need an assistant surgeon. Usually, an assistant surgeon is called in during the surgery when an anomaly or difficulty is discovered. Also if you read deep into the article you’ll find that the man’s insurance company did end up paying the assistant surgeon’s fee.
Here’s the one tip that everybody needs to keep in mind. Doctor’s do not know how billing procedures work. They are usually too involved in treating the patient to worry about each individual insurance policy covers. That’s what medical billers and coders are for and most of us bust our asses to get the most benefit from your insurance company.