Health care is getting more expensive. While many are covered with health insurance, the premiums can also cost as much as $300 for a family every month. The United States, on the other hand, spends more money on health care than other industrialized countries: 17.7% compared to 8.9% of Australia or 11.2% of Canada.
This data was very clear for 37-year-old Peter Drier. The bank technology manager was about to undergo a neck surgery to correct the herniated discs in December, but before he underwent an operation, he verified with his health insurance first that the procedure would be covered.
He also knew how much to spend for the hospital, anesthesiologist, and his orthopedist. Overall, the procedure would cost him almost $200,000. However, he wasn't really worried since aside from the fact that the insurance was going to pay for it, the orthopedist was willing to operate on him for a significantly reduced fee.
Everything went out fine until he received a bill amounting to $117,000. It turned out that a Jamaica Hospital Medical Center neurosurgeon later identified as Dr. Harrison Mu worked as an assistant surgeon in his operation since the hospital lacked a qualified practitioner during this period. What made the bill even more shocking was the fact Mr. Drier couldn't recall talking or even meeting him prior to his surgery.
Since Dr. Mu was out of his network, he brought up his worry to his insurance company Anthem Blue Cross Blue Shield. Fortunately, they decided to foot the bill since the situation wasn't his fault.
The insurance company then forwarded a check to Drier who held on to it hoping to negotiate the assistant surgeon's rates, only to give in when he received a demand letter from Dr. Mu's lawyer.
Analysts, nevertheless, believed that Drier may have been a victim of drive-by doctoring where out-of-network practitioners participate in a procedure in a non-essential or questionable manner, then charging up to 40% their regular fees.
