[jallmann]

> As patient you need to track who is in an out of network

It's worse than that, there are also "tiers" within a network, even for different physicians under the same health group. We were actually debating moving our kids to a different doc (but in the same office!) because of this.

The whole system is madness.

[wil421]

Never experienced what you describe. My pediatric practice is the largest in the state and has like 10 doctors and 10 NPs. We can see whoever we want.

Maybe the health care conglomerates in my city are decent but I’ve never ever tried to book any appointment and been told they are out of network. Never had a hospital experience where some random doctor was out of network but everyone else is.

[ceejayoz]

There's been regulatory action on this in the last few years, but the really insidious scenario here was in-network facilities employing out-of-network staff in ERs and ORs, where several different providers are involved.

https://www.nytimes.com/2022/06/30/well/live/surprise-medica...

> These bills arise because even if you visit an in-network provider, you can still be treated by an out-of-network physician who works there, said Karen Pollitz, the co-director of the Kaiser Family Foundation’s Program on Patient and Consumer Protections. “The doctors who work in hospitals generally don’t work for the hospitals,” she said. “They bill independently, and they can decide which networks they participate in.”

Things like a major operation where the hospital, surgeon, nurses etc. were in-network, but the anesthesiologist - who you may never have even encountered while conscious - was not.

https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur...

> In Mr. Drier’s case, the primary surgeon, Dr. Nathaniel L. Tindel, had said he would accept a negotiated fee determined through Mr. Drier’s insurance company, which ended up being about $6,200. (Mr. Drier had to pay $3,000 of that to meet his deductible.) But the assistant, Dr. Harrison T. Mu, was out of network and sent the $117,000 bill.

> Patricia Kaufman’s bills after a recent back operation at a Long Island hospital were rife with such charges, said her husband, Alan, who spent days sorting them out. Two plastic surgeons billed more than $250,000 to sew up the incision, a task done by a resident during previous operations for Ms. Kaufman’s chronic neurological condition.

> “The idea of having an assistant in the O.R. has become an opportunity to make up for surgical fees that have been slashed,” said Dr. Abeel A. Mangi, a professor of cardiac surgery at Yale, who said the practice had become commonplace. “There’s now a whole cadre of people out there who do not have meaningful appointments as attending surgeons, so they do assistant work.” In Mr. Drier’s case, each surgeon billed for each step of the procedure. Dr. Tindel billed $74,000 for removing two disks and an additional $50,000 for placing the hardware that stabilized Mr. Drier’s spine. Dr. Mu billed $67,000 and $50,000 for those tasks. If the surgery had been for a Medicare patient, the assistant would have been permitted to bill only 16 percent of the primary surgeon’s fee. With current Medicare rates, that would have been about $800, less than 1 percent of what Dr. Mu was paid.