Surprise, Your Doctor Was Out-of-Network


I am sure you will find this amusing:

A new study that looked at more than 2 million emergency department visits found that more than 1 in 5 patients who went to ERs within their health-insurance networks ended up being treated by an “out-of-network” doctor — and thus exposed to additional charges not covered by their insurance plan.

And the average out-of-network bill those patients faced, unless their insurance plan ultimately agreed to cover it, was more than $622, according to the study by two researchers from the Yale School of Public Health and the Yale School of Management.

But the bills can be much higher than that, according to the researchers, who pointed out that one patient they were aware of faced a potential balance bill of more than $19,600. On average, out-of-network emergency department doctors were paid nearly 2.7-times what in-network doctors were paid for the same services, according to the research.

As if you are going to ask a doctor, during your emergency, whether he or she is in-network?  This is lunacy!

Narrow networks, in-networks, out-of-networks, etc.  All meaningless. Can we stop this crap already?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “Surprise, Your Doctor Was Out-of-Network

  1. Ben Van Raalte
    November 20, 2016 at 5:09 pm

    The idea that a doctor group can have an exclusive contract with the hospital (ER, anesthesia, pathology, or radiology) but then not be part of the networks that the hospital is in shows us the mess we have. No wonder those specialties do so well.
    Can you imagine building a house and having a contract with the contractor to build your house, and he hires the usual subcontractors who then bill you more than what the bid was for? That would be illegal and this should be also.
    If your group has an exclusive contract and the patient does not have a choice, then you should either be paid by the contract or limited to 1.2 x Medicare. Period.

    No wonder ER doctors with a 3 year residency and no practice to run are averaging $200 an hour take home now.

  2. Steve O'
    November 20, 2016 at 9:38 am

    The pretense is that “healthcare” and “money” are the same thing. Creating money networks and all that rubbish is meaningless if there is no doctor to do the care. DPC is a direct slap in the face to the insanity that healthcare=money.

  3. Pat
    November 20, 2016 at 8:45 am

    I’m the last guy to ever call for new legislation, but it seems the insurance companies could be hit by forming virtual, or in-kind monopolies by exorbitant price jacks without demonstrating any concurrent benefit to the customer or additional expense to the seller, at the state level. Beyond that, I wonder whether Big Insurance “network” abuses could be clipped inside any legislation providing for interstate insurance sales and portability?

    • politovski
      November 21, 2016 at 8:35 am

      they can. japan does this. its called setting the prices for all the cpt’s across the country. then there are no back alley deals with insurances and different groups over this.

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