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Small surgeries, huge markups

An $87,500 bill for a 20-minute knee procedure is just an extreme example of high amounts that insurers are billed by out-of-network surgery centers, experts say. Insurers are starting to fight back.

January 31, 2013|By Chad Terhune

Overall, Blue Shield said, it expects to have new measures in place by next month to better address these out-of-network billing issues for certain employer health plans. It also said employers should do more to encourage workers to use in-network facilities that are paid negotiated rates.

The Long Beach school district expressed frustration at the teacher's bill, but it echoed Blue Shield's explanation that it will incur additional costs at times because it has promised employees out-of-network benefits.

"This out-of-network issue regarding surgery centers is one that we want to explore with our employee groups in the next bargaining cycle," said Chris Eftychiou, a district spokesman.

Joe Boyd, executive director of the Teachers Assn. of Long Beach, said there is nothing in the employee contract to prevent the school district and Blue Shield from rejecting inflated medical bills.

"That's absurd. It isn't a requirement of the contract to pay fees that are five or 10 times what's customary," Boyd said. "We don't want the school district or our members ripped off."

Nielsen said she remains angry that Blue Shield declined to do anything when she first complained about the situation in December. She plans to continue pursuing the matter with the attorney general's office, which records show has begun an inquiry.

"Our insurance premiums wouldn't keep increasing," she said, "if they paid a fair amount for these procedures."

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