XPost: ba.politics, dc.media, soc.penpals   
   XPost: alt.burningman   
   From: obamacare@sucks.com   
      
   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.”   
      
   In operating rooms and on hospital wards across the country,   
   physicians and other health providers typically help one another   
   in patient care. But in an increasingly common practice that   
   some medical experts call drive-by doctoring, assistants,   
   consultants and other hospital employees are charging patients   
   or their insurers hefty fees. They may be called in when the   
   need for them is questionable. And patients usually do not   
   realize they have been involved or are charging until the bill   
   arrives.   
      
   The practice increases revenue for physicians and other health   
   care workers at a time when insurers are cutting down   
   reimbursement for many services. The surprise charges can be   
   especially significant because, as in Mr. Drier’s case, they may   
   involve out-of-network providers who bill 20 to 40 times the   
   usual local rates and often collect the full amount, or a   
   substantial portion.   
      
   “The notion is you can make end runs around price controls by   
   increasing the number of things you do and bill for,” said Dr.   
   Darshak Sanghavi, a health policy expert at the Brookings   
   Institution until recently. This contributes to the nation’s   
   $2.8 trillion in annual health costs.   
      
   Insurers, saying the surprise charges have proliferated, have   
   filed lawsuits challenging them. In recent years, unexpected out-   
   of-network charges have become the top complaint to the New York   
   State agency that regulates insurance companies. Multiple state   
   health insurance commissioners have tried to limit patients’   
   liability, but lobbying by the health care industry sometimes   
   stymies their efforts.   
      
   “This has gotten really bad, and it’s wrong,” said James J.   
   Donelon, the Republican insurance commissioner of Louisiana.   
   “But when you try to address it as a policy maker, you run into   
   a hornet’s nest of financial interests.”   
      
   In Mr. Drier’s case, the primary surgeon, Dr. Nathaniel L.   
   Tindel, had said he would accept a negotiated fee determined   
   through Mr. Drier’s insurance company, which ended up being   
   about $6,200. (Mr. Drier had to pay $3,000 of that to meet his   
   deductible.) But the assistant, Dr. Harrison T. Mu, was out of   
   network and sent the $117,000 bill. Insurance experts say   
   surgeons and assistants sometimes share proceeds from   
   operations, but Dr. Tindel’s office says he and Dr. Mu do not.   
   Dr. Mu’s office did not respond to requests for comment.   
      
   The phenomenon can take many forms. In some instances, a patient   
   may be lying on a gurney in the emergency room or in a hospital   
   bed, unaware that all of the people in white coats or scrubs who   
   turn up at the bedside will charge for their services. At times,   
   a fully trained physician is called in when a resident or a   
   nurse, who would not charge, would have sufficed. Services that   
   were once included in the daily hospital rate are now often   
   provided by contractors, and even many emergency rooms are   
   staffed by out-of-network physicians who bill separately.   
      
   Patricia Kaufman’s bills after a recent back operation at a Long   
   Island hospital were rife with such charges, said her husband,   
   Alan, who spent days sorting them out. Two plastic surgeons   
   billed more than $250,000 to sew up the incision, a task done by   
   a resident during previous operations for Ms. Kaufman’s chronic   
   neurological condition.   
      
   In the days after the operation, “a parade of doctors came by   
   saying, ‘How are you,’ and they could be out of network or in   
   network,” Mr. Kaufman said. “And then you get their bills. Who   
   called them? Who are they?”   
      
   Doctors’ offices often pursue patients for payment. Ms.   
   Kaufman’s insurer paid about $10,000 to the plastic surgeons,   
   who then sent a bill for the remainder. The couple, of Highland   
   Park, N.J., refused to pay.   
      
   When insurers intervene in a particular case, they say they have   
   limited ability to fight back. Insurance examiners “are not in   
   the room on the day of surgery to see the second surgeon walk   
   into the room or why they were needed,” said Clare Krusing, a   
   spokeswoman for America’s Health Insurance Plans, an industry   
   group. And current laws do not require hospitals that join an   
   insurance network to provide in-network doctors, labs or X-rays,   
   for example.   
      
   Out-of-Network Rates Drive Unexpected Medical Costs   
   When out-of-network physicians perform hospital procedures,   
   hefty charges can be added to medical bills. Insurers often pay   
   the full amount or large portions, which provides an incentive   
   for doctors to include out-of-network colleagues.   
      
   So sometimes insurers just pay — to protect their customers,   
   they say — which encourages the practice. When Mr. Drier   
   complained to his insurer, Anthem Blue Cross Blue Shield, that   
   he should not have to pay the out-of-network assistant surgeon,   
   Anthem agreed it was not his responsibility. Instead, the   
   company cut a check to Dr. Mu for $116,862, the full amount.   
      
   Unexpected Fees   
      
   When Mr. Drier agreed to surgery in December, he was not in a   
   good position to bargain or shop around. Several weeks earlier,   
   he had woken up to excruciating pain in his upper back and   
   numbness and weakness in two fingers of his left hand, which   
   persisted. A scan showed that one of the disks that normally   
   serve as cushions between vertebrae was herniated and pushing on   
   a nerve. With a busy job and social life, he was living on   
   painkillers.   
      
   The rate of spinal surgery in the United States is about twice   
   that in Europe and Canada, and five times that in Britain, said   
   Dr. Richard A. Deyo of Oregon Health and Science University, who   
   studies international comparisons. Studies are limited but have   
   generally concluded that after two years, patients who have   
   surgery for disk problems do no better than those treated with   
   painkillers and physical therapy — although the pain, which can   
   be debilitating, resolves far more rapidly with surgery.   
      
   The United States has more neurosurgeons per capita than almost   
   any other developed country, and they compete with orthopedists   
   for spinal surgery. At the same time, Medicare and private   
   insurers have reduced payments to surgeons. The average base   
   salary for neurosurgeons decreased to $590,000 in 2014 from   
   $630,000 in 2010, according to Merritt Hawkins, a physician   
   staffing firm.   
      
   To counter that trend, some spinal surgeons have turned to   
      
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