Surgeon Charges $117,000 – and Receives – for Assistant Fee

A couple of weeks ago, my car’s battery died. It was dead-dead. Was never going to take a charge.

AAA has a service where they will put in a new battery – instead of just giving you a jump. While the price seemed high- $128- it did not seem unreasonable. I’d be done. I wouldn’t have to turn this into a two step procedure, step 1: jump; step 2: get a new battery at a lower price elsewhere.

The next morning, the driver contracted by AAA called me. He made an error. Instead of charging my credit card $128, he accidentally charged $12,800. (That immediately made me feel inadequate about the tip I gave.) The driver said he was calling to let me know his company issued a credit. Whew.

The NY Times published an article on “drive-by” billing. It referenced a patient who had a cervical fusion. No mention was made the surgery was anything other than routine. The patient did well.

This patient had done his homework in advance. The facility and primary surgeon were both in network. He believed his out of pocket obligation would be $3,000.

He received a bill from both the primary surgeon and the assistant surgeon. Note: The primary surgeon (in-network) and the assistant surgeon (out-of-network) apparently share a business address.

The primary surgeon was paid the in-network rate. The assistant surgeon sent the patient a bill for $117,000. The insurance carrier initially refused to pay that sum.

In New York, next year, a new law will offer some protection against surprise charges and require more advance disclosure from doctors and hospitals on whether their services are covered by insurance.

“It states, for example, that patients are not responsible for unforeseen out-of-network charges beyond what they would have paid in-network. It directs insurers and hospitals to negotiate any further payment or enter mediation.”

The patient complained to his carrier, Anthem Blue Cross, that he should not be responsible for $117,000 for an assistant fee with an out-of-network surgeon he never met. Anthem agreed and cut a check to the assistant surgeon- and mailed it to the patient.

For months, the patient agonized over what to do with the check. He believed the amount was “outrageous and immoral.” He also believed such payments could drive up premiums at his employer.

“[The patient] tried to negotiate with the surgeons to divvy up the $117,000 payment in a way he believed was more fair; he liked Dr. Primary Surgeon and felt he was being underpaid. [The patient’s] idea, he wrote in an email, was to settle on “a reasonable fee for both the surgeon and assistant and return the rest of the check to the insurance company/employees” of his company.”

The assistant surgeon’s attorney sent a threatening letter to the patient in July warning him to sign over the check. He did.

The news story went viral. The assistant surgeon will forever be remembered as the person who gouged a patient he never met. Perhaps he felt like he was sticking it to the insurance company. There are certainly myriad reasons to feel that carriers take advantage of in-network doctors. But, $117,000 for a 3 hour procedure as an assistant – a role often filled by a scrub tech or a resident – reeks of excess. And if it is true the patient would have been theoretically on the hook for the full bill if he sent the check back to the carrier, the bigger faux pas was having the attorney threaten the patient with litigation.

Sadly, such anecdotes – publicized by the media- make all doctors look bad. May be the assistant surgeon is laughing all the way to the bank. I wonder if he’d do it the same way next time.

With this as backdrop, $12,800 for my battery seems like a bargain.