Patients across the country are being hit with unanticipated hospital charges due to the increasing practice of "drive-by doctoring" — calling in consultants and other healthcare workers whose presence may not be needed and who may be out-of-network, resulting in sizable additional fees, according to a report from The New York Times.
The Times gives the example of bank technology manager Peter Drier, who had neck surgery for herniated disks in December and was surprised by a $117,000 bill from an "assistant surgeon" he didn't remember being involved with his care — Harrison T. Mu, MD, a Queens-based neurosurgeon who is out-of-network for Mr. Drier. Dr. Mu's office could not be reached for comment, according to the report.
Health insurers have said unexpected charges like the bill Mr. Drier faced have become increasingly common: These surprise fees from out-of-network providers have risen to the top of the list of complaints received by New York State's insurance regulation agency, according to the report.
The issue has led some to question whether hospitals and health systems are calling in unneeded consultants and assistants so they can inflate bills to compensate for reimbursement rate cuts. Abeel A. Mangi, MD, a professor of cardiac surgery at Yale University, told the Times assistants have been brought into operating rooms to "make up for surgical fees that have been slashed." He said he has been required to request physical therapy consultations before discharging patients, even if he thought it wasn't necessary, due to "a mushrooming industry of mandatory consultants."
Some health insurers have fought the surprise fees by filing lawsuits against providers. However, their capacity to push back against hospitals is limited, since insurance company examiners aren't present during the patient's care to determine whether the assistants, consultants or other employees brought in were necessary, America's Health Insurance Plans spokeswoman Clare Krusing told the Times. Additionally, hospitals in insurance networks aren't legally obligated to provide in-network services, according to the report.