Peter Drier, 37, a bank technology manager in NY city, signed several consent forms, prior to his three-hour neck surgery for herniated disks in December.
Drier had researched his insurance coverage and he was ready for the medical bills coming: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and even $133,000 from his orthopedist.
But a bill of about $117,000 from an “assistant surgeon,” Dr. Harrison T. Mu, a Queens-based neurosurgeon who was unknown to Drier, shocked him.
“The notion is you can make end runs around price controls by increasing the number of things you do and bill for,” said health policy expert at the Brookings Institution, Dr. Darshak Sanghavi. This contributes to the USD 2.8 trillion in annual health costs in the US.
In an continuously emerging practice referred as drive-by doctoring, assistants, consultants and other hospital employees produces large bills to patients or their insurers. They may be called in when the need for them is questionable. Patients are usually unaware about their involvement until the bill is produced. The practice significantly lead to a rise in revenue for physicians and other health care workers at a time when insurers are cutting down reimbursement for many services.
“This has gotten really bad, and it’s wrong,” commented James J. Donelon, the Republican insurance commissioner of Louisiana.
“But when you try to address it as a policymaker, you run into a hornet’s nest of financial interests.”
An X-Ray scan of Drier revealed one of the disks that normally serve as cushions between vertebrae herniated and pushing on a nerve.
Drier’s was worried about the extra amount being charged while he was going through pre-operative tests. The hospital sent his blood tests to an out-of-network lab and required him to have an echocardiogram that eventually amounted to $950 which was not acceptable as Drier had no cardiac history.
According to The American Society of Echocardiography patients with no heart problem should not undergo such testing.
On the morning of his surgery a technician from a company called Intraoperative Monitoring Service LLC asked Drier to sign a financial consent form, saying that the company did not accept Blue Cross Blue Shield plans, so he has to pay the bill himself.
The monitoring that is said to be essential is already ordered by his surgeon.
“I demanded to know the price, and when he said he didn’t know, I made him call,” Drier said recalling. Drier negotiated $500 plus an hourly rate to $300.
In a case in New Jersey, Mark Sullivan, 46, was admitted to an emergency room last year due to lower back pain and leg weakness where he resided for less than 24 hours later.
“The surgeon stood at the foot of my bed and said, ‘You need surgery; you won’t walk out of the hospital,'” he recalled.
Sullivan’s emergency admission made it trouble free for an out-of-network surgeon to perform the operation and charge $29,000. The insurer paid $9,500, and Sullivan paid about $580, as required by his plan. Sullivan agreed to file an appeal with his insurer for additional payment, but not pay himself when the doctor’s billing office pursued for the balance of the bill and even frightened to turn his account over to collection.
In Drier’s case, each surgeon billed for each step of the procedure. The primary surgeon, Dr. Nathaniel L. Tindel, billed $74,000 for removing two disks and an additional $50,000 for placing the hardware that stabilized Drier’s spine. Mu, the chief of neurosurgery at Jamaica Hospital Medical Center in Queens, billed $67,000 and $50,000 for those tasks.