New York Times reporter Elisabeth Rosenthal has written another eye-opening article in this past Sunday’s edition. The article entitled, “After Surgery, Surprise $117,000 Medical Bill from Doctor He Didn’t Know,” documents the duplicitous billing habits of some physicians who act as ‘assistants.’
In surgery or in a procedure, a doctor may use another doctor to ‘help out’ or ‘assist.’ That additional doctor will often bill for the full surgery or procedure as well and to make matters worse—that ‘assisting’ physician could be out-of-network, resulting in charges of tens-of-thousands of dollars. Often, a doctor may use a physician’s assistant to work alongside him or her during a procedure (holding back retractors, doing some of the suturing, etc), however, often the fees for a physician’s assistant will be included in the overall surgeon’s fee. Using another doctor to assist rather than a less expensive physician’s assist seems to have become more commonplace.
I will tell you in Compass’ experience, we have even encountered out-of-network physician’s assistants trying to recoup excess fees from our members. Five years ago, Compass had a member who was being billed an additional $25,000 by an out-of-network physician’s assistant for a breast cancer surgery. Compass fought those charges, arguing that the physician’s assistant should have been paid as part of the overall surgeon’s fees. When Compass contacted the surgeon, his office claimed that they did not even know that the physician’s assistant was charging extra—and they were pretty upset about it and contacted the physician’s assistant directly themselves as well.
The article by Elisabeth Rosenthal goes on to discuss ‘consults’ by doctors, physical therapists and occupational therapists who see patients during their stay. Many of these consults are very short, add little value and according to the article, sometimes the operating surgeon doesn’t even want them, but they are encouraged by the hospital. However, these consults—again often by out-of-network doctors—result in additional bills and fees that amount to thousands of dollars.
What does this mean for healthcare consumers and employee benefits professionals?
- Being a passive patient in a hospital can result in excess visits by doctors and other healthcare providers that could end up being very expensive and wasteful.
- ‘Speaking up,’ asking questions and questioning the utility of consultations is not unwarranted and ASK if the provider is in-network and if they are not, complain to the head doctor, the hospital and the insurance company. As the article points out, you can fight and/or prevent these charges.
- If you are an employee benefits professional, analyze your claims data for the number and cost of ‘assistants’ and consultations during hospitalizations. You will be able to identify providers who are the ‘worst offenders’ and then steer employees away from these providers to more ‘rational’ ones.
To learn more about the disconnect between cost and quality in healthcare, click on the link below: