I think it is a tricky situation. For example, you might authorize a minor surgery for instance, only for the surgeon to realize there is a larger problem and they need to perform a more expensive procedure. If you are unconscious, there is no way to get consent, and likewise you want providers to have the flexibility to perform time sensitive procedures without concern that it would never be paid for because there wasn’t prior consent.
That’s not where the surprise is coming from. The surprise is that the hospital failed to tell you there might be out-of-network staff that might be involved in your surgery, even though you were careful to choose a hospital that is in-network. So your insurance won’t cover the out of network doctors, and you don’t have any choice of how many or which other doctors (other than your scheduled surgeon) get involved. Those out of network staff then bill you separately from the whole procedure. That’s the surprise.
There’s an easy solution for that, you pay only fee of sum x for any surgery, the rest is paid by your insurance. They have the money, power and leverage to actually realise competition in the medical field
I think it is a tricky situation. For example, you might authorize a minor surgery for instance, only for the surgeon to realize there is a larger problem and they need to perform a more expensive procedure. If you are unconscious, there is no way to get consent, and likewise you want providers to have the flexibility to perform time sensitive procedures without concern that it would never be paid for because there wasn’t prior consent.
Insurance is required to cover emergency measures though if im not mistaken.
That’s not where the surprise is coming from. The surprise is that the hospital failed to tell you there might be out-of-network staff that might be involved in your surgery, even though you were careful to choose a hospital that is in-network. So your insurance won’t cover the out of network doctors, and you don’t have any choice of how many or which other doctors (other than your scheduled surgeon) get involved. Those out of network staff then bill you separately from the whole procedure. That’s the surprise.
There’s an easy solution for that, you pay only fee of sum x for any surgery, the rest is paid by your insurance. They have the money, power and leverage to actually realise competition in the medical field