The whole warped part of this is that the consumer has no way to anticipate cost in advance, and often the individual providers (doctors, nurses, etc.) don't either. Shouldn't the burden be on the insurance company to investigate and discourage excessive billing? Or are they too strict as it is, leading providers to play games with billing?
I think in this particular case insurance did investigate actual (or within a reason) costs and paid them. But there is no business relationship between the insurance company and an out-of-network provider. Should they go to the court on behalf of the patient? As a customer I'd like this. But it looks like combining health and legal insurances.
Another option is maybe to require that language on the "patient responsibility form" to include the blurb about fair prices. For instance:
In the event that my health plan determines a service to be “not payable”, I will be responsible for the complete charge and agree to pay the usual, customary, and reasonable costs of all services
provided.
Is there an analogy in the car insurance world? Let's say I know nothing about cars and I get in a collision somewhere far away from home. I need a repair th let's say I know nothing about cars and I get in a collision somewhere far away from home. I need some bodywork and a replacement for the flimflam crankslap in the engine. The shop knows that I don't know anything about cars, and they know that I am covered by insurance. What is stopping them from charging me an exorbitant rate for a new crankslap, and then me getting screwed when the insurance won't cover it?
