Originally published October 12 2014
Profiteering neurologist Harrison Mu charged man $117,000 for unnecessary surgical assistance
by PF Louis
(NaturalNews) It's not unusual for other health practitioners to be called into a case for assistance. The standard ethical practice is to advise the patient of that situation. But a rather unethical but increasingly common practice nicknamed "drive-by doctoring" has come into play.
Out-of-insurance/health-provider-network surgeons are called in and the patients don't know about it until they receive their bill. Beware, sticker shock can interfere with surgical recovery. One such sticker shock occurred in New York City when bank technology manager Peter Drier received his bill after neck surgery for herniated disks.
Peter had researched the costs for his orthopedic doctor, Dr. Nathaniel L. Tindel, who agreed to collect a reduced portion of his normal $133,000 fee, a $6,200 fee, because that was the limit allowed within the insurer/health provider network that he and Peter's insurer shared.
Peter ensured that his insurance provider would cover the hospital bills and Dr. Tindel's negotiated charge as well as the anesthesiologist's cost. Even with this coverage, he had to pay his deductible of $3,000.
Drier was blindsided with an additional triple-digit bill
But as the bills came in, there was one that wasn't expected at all, and it was for just under $117,000. It seems that a neurosurgeon popped into the operating room without Peter's knowledge who was conveniently out of the network that provides reduced costs.
Dr. Harrison T. Mu was able to "legitimately" charge his full fee. Peter got that bill in addition to his others that were within limits for his insurer.
When Peter complained to his insurance provider, Anthem Blue Cross Blue Shield, that he didn't want to pay Mu's bill, he was told not to worry, they would cover it. They cut a check made out to Dr. Mu for $116,862, the exact amount of Dr. Mu's bill. There is quite a disparity between network doctor fees and non-network doctor fees.
Some health insurance experts explain this method of inviting another physician who is not part of the same network to "assist" in a procedure is a convenient way for the primary physician or surgeon to collect more by having the "assistant" share part of the proceeds that he or she manages to ultimately receive.
The tendency for insurers to pay surprise bills on behalf of their clients only encourages this deceitful practice. When The New York Times reporter on the Peter Drier story questioned Dr. Tindel's office, she was told that Tindel and Mu do not have a working relationship. Dr. Mu's office refused the reporter's calls. A rather suspicious scenario, it seems.
Incidents like this have been the number one health insurance complaint in New York
The sneaky practice of using an out-of-network assistant for stretching way beyond the limits of allowable network payments and perhaps enabling the primary doctor or surgeon to share the difference with his surprise assistant is just one of the ways of creating surprise bills and raising healthcare costs nationwide.
Another medical billing trick is using out-of-network specialists to perform activities that a covered hospital intern could easily handle. And out-of-network health providers can claim that an operation is an emergency, even if it's not. Insurers are forced to cover emergencies handled by out-of-network doctors.
All these techniques result in surprise bills and raise national health costs.
But some insurers have recently begun filing lawsuits against those out-of-network doctors who are playing tricks and issuing surprise bills. Recently, a bill was passed in New York State that is designed to curb this practice. The bill becomes law in 2015, still time for some surgeons to cash in.
"The heart of the bill came out of the fact that the No. 1 complaint on health insurance issues we receive year after year is people who get stuck with surprise balance bills," explained Benjamin Lawsky, superintendent of New York State's Financial Services Department.
Lawsky feels that this law will set a precedence for other area lawmakers to follow in the near future.
Sources:
http://www.nytimes.com
http://uncovercalifornia.com
http://www.nytimes.com
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