I am responding to an article appearing in the New York Times that other publications quoted about the patient who was billed $117,000 by a secondary surgeon who he never met nor knew was going to be in the OR at the time of his surgery.
There is a question of whether he was actually needed and whether a resident could have performed the service he provided. In addition, he was out of network, which according to your article meant that his fee was four to 20 more than the usual fee.
I have no idea whether his services were necessary or whether $117,000 is a customary and usual fee since I don't know the details of the surgery.
However, I do question the four to 20 times more than the "usual" fee. Typically, managed care companies have reduced participating doctors' fees to about a third of the usual and customary fee. In other words, if a doctor is foolish enough to accept the ridiculously low fees paid by insurance carriers, then they must accept these reimbursements that were paid in the 1970s and early 1980s.
By remaining out of network, the doctors can bill customary and usual fees which are more in line with 2014. Unfortunately, there are some doctors who abuse the system and charge insanely high fees.
I am not condoning this, just clarifying that the in-network fees are well below customary and usual and barely permit most doctors from making any profit.
Dr. Jay H. Schwartz