First, we had Unethical American Dentistry, and now — perhaps thanks to Obamacare — we have certain American physicians who are playing loosely with the truth when it comes to telling patients if they are “in-network” with their insurance plan, and providing the right, covered, care for their patients. “First Do No Harm” is not an oath to these doctors, it’s a cue down the path of anathema!

The scheme is really quick and cunning, and these doctors that have been highly recommended to you by other physicians, rely upon you trusting their word that they are, actually, in-network — when they are not — and that you will not be smart enough to call your insurance company beforehand to check and see if your doctor is lying to you or not.

Then, once services have been rendered, you get an outrageous bill from your out-of-network doctor sent to your insurance company — yes, your copay has already been collected in office and your insurance card was copied and processed by the physician’s administrators in evil — but none of it is honest or authentic, because the doctor already knows what you do not: Your insurance company isn’t going to pay the bill because you’re using an out-of-network doctor.

All drama and no saga!

When a patient actively chooses to go out-of-network, that decision is never taken lightly, and most patients would never dare to stray from their paid for in-network coverage because all the money you spend on insurance premiums help you not when you go out-of-network, and most insurance companies hold a patient to something like a $1,000 deductible before they even think about paying a little bit of out-of-network fees.

Some doctors know that deductible scheme, and they purposefully over-bill your insurance company for their services. If they want to be paid, let’s say, $2,000 for services, then they’ll send a bunch of bills — totalling, again, let’s say $10,000 — to your insurance company and that will push you over your deductible and then they’ll bleed a check out of the insurance overage against your deductible and then claim to do you a “favor” and waive the rest of what you “owe” them for services rendered by saying they’ll take the check your insurance company paid you without you having to foot the bill for the deductible.

Nice scam, eh? I thought Obamacare was supposed to end this sort of purposeful, devious, deception? If a doctor rips off your insurance company with inflated billing, your doctor is ripping you off, as well.

The nastier trick comes when you have a more greedy doctor who, even after getting paid something by your insurance company, will then turnaround and still bill you for the remainder fees, but in order to look like a caring doctor who is on your side, the doctor will say the price you “owe” is only 10% of the balance — now that may sound like a deal, but it isn’t when you’re being asked to pay $100 on a $1000 office visit and you only pay, under your own insurance plan for an in-network doctor, $20 an office visit!

The pain is in the fear; the power is in the threat; in the execution, the damage!

The rattles come out if you disagree — and the not-so-veiled aggression of suggesting taking you into collection — and you are left to either fight against the first lie the doctor told you about being in-network, or losing some points on your credit rating in the second coming, or giving in to the scam and paying five times the amount of your normal copay just to make the problem go away.

Instead of blaming the patient for trusting that a doctor would not lie about being in-network or not, States like New York have enacted a “Surprise Healthcare Bill” law to help patients fight against these nefarious physicians. Just because you have an M.D. after your name doesn’t mean you are moral or kind or not a dregs of society. The surprise New York law went into effect, fittingly, on April Fool’s Day, 2015 — and not a silly moment too soon!

The Surprise Healthcare Bill law in New York is specifically aimed at helping patients negotiate a fee settlement who are lied to by their doctors about being in-network. In the old system, if you were out-of-network, your insurance company denied your claim and calculated your out-of-pocket deductible and left you to rot in the sun with the wolves.

In the new system, your claim will still be rejected by your insurance company, but you can now call the insurance company and ask them to negotiate a fair price for the out-of-network services rendered because your doctor lied to you about being in-network.

The Surprise Healthcare Bill law isn’t great, but it’s a start — and puts out-of-network doctors on high notice that the system is on to them and that lawmakers are actually helping patients find a way around the Sisyphean “yes, I’m in-network” lie that some doctors tell their patients in order to extort them later — and yes, “extort” is the right word because those doctors know precisely what they’re doing and how the endgame will win out in the end.

They think they can wring more money from a scared patient in pain than they can from a cold and calculated insurance company. The strong prey on the weak, and your doctor preys on you because the insurance company preys on your doctor and both prey on you in tag-team tandem to wring the health out of you!

Now there’s no more of you claiming “I didn’t know my doctor was out-of-network!” versus your doctor’s calm plaintive, “Of course I said I was out-of-network!”

What cogent patient, in their right, frugal, mind, would ever agree to see an out-of-network doctor for a common hospital procedure that could be performed by a multiplicity of good doctors who are actually in your network insurance plan? That’s the reasoning the bad doctors hope you’ll refuse to cling to in the end.

When your hospital bill is less than your doctor bill — something evil is wrong! — unfortunately, good things happen slowly, so we must divine that for a Surprise Healthcare Bill law to actually go into effect means this problem has already been a long, horrible road, for many patients, across many years.

It’s good to know that, sometimes, the little guy wins — and the voice of the people is heard, and acknowledged! — far beyond the din of the profiteers and the hardscrabble for-profit bandits preying on unwell patients and their families, who are desperate to feel better at any price, even a negotiated one that betrays their own self-interest.

4 Comments

    1. Yes, it’s pretty terrible and I thought Obamacare was invented to stop this sort of shenanigans. This trick can only be pulled with good people who have private insurance and who care about their credit rating — if you’re on Medicare or Medicaid, a doctor can’t press you for uncovered balance payments.