You need to be really careful. I saw an interview with one woman who had some kind of abdominal surgery. Six weeks after the surgery, she got this huge bill. It turned out that the assisting surgeon and one of the surgical nurses were out of network. That’s not something you’d think to ask when you’re on the operating table.
“You need to be really careful. “
Very true. I had abdominal surgery at a local in-network hospital. My surgeon was in-network. Since I was using an in-network hospital and surgeon, it never occurred to me to investigate the anesthesiologist and radiologist which were selected by the hospital. Both turned out to be out of network and I received bills from them for the difference between what the insurance company paid and what they billed the insurance company. I
n fact, the anesthesiologist’s total bill was more than the surgeon’s total bill. After insurance payment, the amount the anesthesiologist demanded was $8000 for a 45 minute procedure the surgeon billed $5200. The anesthesiologist was attending multiple patients during the procedure, so was collecting from multiple patients, while the surgeon was focused on one.
In fighting the charge I discovered all of the anesthesiologists and radiologists in the region have declined to join any network so there is no way to have surgery at any of the six hospitals (3 groups) in the region with in-network anesthesiologists and radiologists. They routinely bill the patient for the difference between insurance reimbursement and their inflated bills. If the patient cannot pay, the bills are given to a collection agency and ultimately legal action is taken. Apparently Medicare and Medicaid patients are not subjected to this billing procedure but private insurance patients are billed.
Consider the tens of thousands of surgical patients in my area discovering this problem after the fact and finding themselves owing thousands of dollars to hidden out of network providers. While the anesthesiologists and radiologists today are laughing all of the way to the bank, they are creating advocates for a government run single payer healthcare system with every patient they fleece as are the hospitals enabling this scam through lack of transparency.