Sunday, September 21, 2014
How to Skate Around Obamacare (Maybe)
This article appeared in the New York Times this weekend. It relates mostly to surgical fees and billing, but I found it interesting. The gist of it is that even when savvy patients go in for surgery with a surgeon they know is approved by their insurance plan, and make sure the procedure is scheduled at the hospital contracted with said plan, they can still get hit with unexpected fees if the surgeon calls in a noncontracted assistant. In many cases the assistant is in the same office as the surgeon in charge of the case. It's easy to infer that the assisting surgeon's higher fee is likely split with Surgeon #1.
In other cases, patients reported that a hospitalist or internist who appeared on their hospital bill as rounding on them daily never in fact showed up. Or they got an echocardiogram that they didn't actually need for surgical clearance. Or other things.
The surgeons, in many cases, blamed the hospital for the extra procedures and charges; they state that due to the drop in reimbursements this is the hospital's way of getting additional cash. As for the assistant issue, it actually is common for surgeons to have an assistant on their cases. It makes things much easier and faster in the OR to have someone retracting the edges of the wound, assisting with suturing, and so forth. My father, in fact, did this for many years on his patients. This was well before the era of managed care. His specialty was family practice, but he was deft and smart, and the surgeons loved working with him. However, he did not bill for the astronomical sums mentioned in this article; he was just an assistant, and "out of network" was not a concept that applied at that time.
If the surgeon knows he or she is going to need an assistant on the case it is his responsibility to explain this to the patient (including exactly why one is needed) and to make sure the assistant is contracted with the patient's insurance plan. As someone who works for a large group which employs lots of staff who deal with this exact issue, I'm kind of surprised this ploy is as frequent (and successful) as it apparently is.