Tuesday, December 14, 2004

Doctor insurance scam

We have been dealing with what appears to be a scam by an anesthesiologist. In September, our daughter was born by cesarean. We knew that the surgeon and the hospital was a part of our health insurance network, so we knew that their charges would be covered.

A couple of months later, we received a bill for the anesthesiologist, requesting payment, since the insurance company only payed 70%. Since the hospital assigned the anesthesiologist, and the hospital was under the contract with the insurance company, I though that it was strange that the anesthesiologist wouldn't be covered. I call my insurance company, and then they said that they agreed to pay 100%. But that is 100% of what they deem to be the correct cost. So I am still liable for the difference.

It looks like doctors can charge what ever they want for a service, and the patient is liable for it. This is really bad for anesthesiologist, especially since the patient is wheeled into the OR not knowing who the anesthesiologist will be and whether they are under contract. An anesthesiologist could charge $10,000 for a surgery without the patient knowing how much it would cost.

This issue came up at El Camino Hospital. Here is the San Jose Mercury News article.

The next time that we go, we are going to make sure that the anesthesiologist is under our insurance contract.


  1. Insurance companies do too. I would recommend watching "Dead Doctors Don't Lie".

  2. The same thing happened to us. My fiance was in for a vocal cord polyp removal. Both the hospital and surgeon were covered under our insurance but not the anethesiologist. We had assumed that the hospital would choose an anesthesiologist under the same insuranc. We were wrong and now we're stuck with a bill. Is there anyway to negotiate a lower bill?


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