6 insidious ways you’re getting ripped off

6 insidious ways you’re getting ripped off

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 The out-of-network doctor trap
The rip-off: You need medical treatment. You dutifully check the listings from your insurance provider to choose an in-network doctor or hospital. After your treatment, you receive a surprise in your mailbox—a giant bill, perhaps for many thousands, or even tens of thousands of dollars. Why? A person involved in your treatment, unbeknownst to you, is considered out-of-network. This is the out-of-network doctor trap, a.k.a. the surprise billing scam.

This can happen in a doctor’s office for a simple scheduled procedure or in a hospital for an emergency. Sometimes it’s the assistant surgeon. Others times it’s the radiologist, pathologist or anethesiologist. In a practice called “balance billing,” you get billed the difference between what your insurance chooses to reimburse and what the provider chooses to charge. You may think that your insurer is supposed to reimburse you for 70 percent of out-of-network costs, but that really means only 70 percent of what the insurer determines is “usual, customary and reasonable.”

And what does reasonable mean? Whatever the insurer says it means, which is often far less than what the out-of-network doctor charges. Insurers often manipulate claims and data just to screw you: In 2009,UnitedHealth had to pay a big settlement for this type of fraud when then-New York Attorney General Andrew Cuomo investigated and sued. But fines don’t stop these big insurers – the money they make from scamming is too good.