NY Times Article On After Surgery Bill: My Comments

Elizabeth Rosenthal wrote a thorough and revealing article in the NY Times called

“After Surgery, Surprise $117,000 Medical Bill From A Doctor He Didn’t Know”.


This is a must read to understand what many patients experience.  I have dealt with this much too frequently with clients.  Hospitals and doctors overcharge and it isn’t known until after the fact.  Often attempts to get an idea of cost are rebuffed by billing offices.  The client then gets a shock when the bill arrives.

What struck me about the article that exposes the practices of many hospitals and doctors is the misuse and deceptive practices of getting the informed consent.  It is the informed consent, a legally binding document, is where the patient’s power lies.  Most patients don’t realize what their signature on the form translates into.  It is the last step in a process that allows the patient to be in control of long-term outcomes from potential outrageous billing to winning malpractice suits for medical error.

The informed consent is supposed to be the form that verifies that the medical team has explained in detail the procedure or surgery, which is going to perform the procedure and what the possible adverse reactions could be.  The medical team by law has to provide this information.  Unfortunately, my experience dealing with the healthcare system, most medical teams treat the informed consent as routine and expect patients to sign no matter what.  I have been with patients when a medical team member has come into the room, talked to the patient, never said the paper was the informed consent and then asked the patient to sign.  I stepped in and asked for the doctor to explain what the form meant.

On all informed consent is a paragraph that states the surgeon, doctor or other person may use other medical professionals like residents, attending, medical students and allied health professionals if they feel it is necessary.   The patient has the right to know who exactly will be in the surgical theater touching your body.  The patient also has the right to cross that off and not allow it.  I have a friend who is a surgeon who told me to have my clients say, “I want this done by you skin to skin.”

This means from first cut to last suture.  After this article, I would add to the informed consent that the medical team has informed me of all the people who will be present during the procedure/surgery.  Ask for a copy of the informed consent.

If a patient signs the consent without any changes, then the medical team has free rein.  The patient’s doctor may not be performing the procedure and in some instances, not in the room.  Legally, you have given the medical team permission to proceed, as they like.

My other advise is don’t agree to sign the informed consent unless a family member, friend or advocate is with you.  Consents have been known to be missing from charts more than I would like.  Medical teams like to have the consent signed when the patient is alone in pre-op, a vulnerable and stressful time.

If a statement like the above is on the informed consent, an unknown medical professional cannot bill because you did not approve.  It is a very strong safety net.  The doctor would have to prove that his/her presence was medically necessary and there was no other doctor available.  The interesting part of the story is the patient’s surgeon had to have set up ahead of time the out of network doctor because the out he practiced at another hospital in another borough.  It is absurd to think the out of network was called and drove in an emergency to assist.

As consumers, we need to push back.  We need to get smarter and use the tools available to us.  The informed consent is one of those tools.  The medical teams are just trying to pull a fast one.