A major medical procedure is often followed by significant pain and a long recovery. For many patients, the surgery itself is simply the beginning of a lengthy, and often painful, road to recovery.
But for some patients, a significant procedure is followed by almost instant relief.
That was the case for Liv Cannon, a 26-year-old from Austin, Texas who suffered from unexplained chronic back pain and muscle weakness for most of her life and was recently profiled in NPR’s Bill of the Month series. After years of inconclusive doctor visits that left her wondering whether she’d ever find answers and an escape from the pain, Liv visited a specialist who discovered a rare disorder that caused a tumor to grow on her spinal cord.
After a successful spinal surgery, Liv experienced almost instant relief… until a surprise medical bill for $93,991.58 arrived in her mailbox.
The cause of the exorbitant bill? A neuromonitoring service provided during the spinal surgery.
The service was an important part of her overall surgery, meant to detect potential damage to her nerves during the procedure. The catch was that the monitoring was charged as a separate service from the spinal surgery, because it was provided by a company that was out-of-network with her health insurance provider – even though her surgeon was in-network.
How is this fair?
Specialty service providers who choose to remain out-of-network in order to demand a blank check from patients are clearly taking advantage of a loophole in our current health system. Worse, according to Richard Vogel, president of the American Society of Neurophysiological Monitoring, some of these neuromonitoring firms even charge these excessive fees so that they can “kick back” part of the money to surgeons.
Liv’s story is a perfect example of why we need to put an end to surprise medical bills that deny too many patients access to the affordable, high-quality coverage and care they deserve. It’s also a case-in-point why establishing a benchmark rate for reimbursing out-of-network services is such a critical part of the solution. Under an arbitration model, specialty providers would be incentivized to raise prices even higher, so after a costly and bureaucratic negotiation process they could still receive $100,000 windfalls. A benchmark rate tied to negotiated rates would ensure patients are protected from these egregious charges.
No patient who found relief in a major medical procedure deserves the pain of a surprise medical bill.