Did you catch last month’s New York Times article about the healthcare industry’s hundred thousand dollar surprises? It’s not that patients are getting checks in the mail from their hospitals. Rather, doctors, medical technicians and other healthcare specialists are charging outrageous amounts for their services, sometimes without the patient realizing a service has been performed, sometimes without the procedure even being performed.
Before his three-hour neck surgery for herniated disks in December, Peter Drier, 37, signed a pile of consent forms. A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and even $133,000 from his orthopedist, who he knew would accept a fraction of that fee.
He was blindsided, though, by a bill of about $117,000 from an “assistant surgeon,” a Queens-based neurosurgeon whom Mr. Drier did not recall meeting.
“I thought I understood the risks,” Mr. Drier, who lives in New York City, said later. “But this was just so wrong — I had no choice and no negotiating power.”
The article notes other incidents, too. One patient with a chronic neurological condition went in for a routine procedure. She was billed $250K by two plastic surgeons. In the past, a resident had sewn up the incision for much less. Another patient arrived in the ER of a hospital, was not allowed to leave without undergoing a surgery, and was then pursued for the $18K balance of a bill. Many of the charges on his bill were unidentifiable. That patient insists some of the procedures were never even performed.
What to make of all this? And how worried should you be? Our current healthcare system financially rewards doctors and facilities for the number of tests, visits and procedures they conduct. One medical professional says that these types of excessive charges are mushrooming in the healthcare industry. We may well ask why. Often, it’s less of a hassle for the insurer to just pay. Sometimes they will. But what happens to the patient when the insurer won’t or can’t pay?
At Sherpaa, we take preventive measures. When a Sherpaa client needs a surgery, our staff doctors and insurance navigators are with the patient every step of the way. Our first step is to make sure the physician they’re seeing is in-network. Then, we’ll request a Predetermination of Benefits Summary from the client’s insurance provider to know what charges can be anticipated. Prior to surgery, the patient will have a pre-op consultation with their provider. We always instruct our clients to ask their surgeon who will be on their team on the day of the procedure. If any other physicians will be participating in the surgical procedure, the patient should contact Sherpaa with a list of names to verify that those physicians are in-network too. When you work with in-network physicians on a costly procedure, know in advance how many healthcare workers will be on your case and understand what parts of the procedure are covered, you’re a lot less likely to be billed an expensive surprise.
To learn more about how Sherpaa can help you and your employees, click here.