In a Washington Post opinion piece, Cynthia Weber Cascio, a principal at M&C Media, shares her experience of being forced to negotiate surprise medical bills totaling $17,000 directly with her surgeon—a practice she claims is "akin to telling the victim of a mugging to ask the thief for their purse back."

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The procedure

About a year ago, Weber Cascio experienced stomach discomfort. She originally thought the problem was something she ate, but the symptoms worsened overnight. She developed a 102-degree fever, and a pain on her lower right side that made it "difficult to lift [her] leg."

"By dawn, I knew it was appendicitis and told my husband we had to go to the hospital," Weber Cascio writes.

Although she had several options for care, Weber Cascio felt "so sick" that she chose a nearby hospital, which she wrote "we have long trusted for our family's health."

At the hospital, clinicians confirmed she had acute appendicitis and "would need surgery immediately," she writes. Weber Cascio was reassured when the ED physician told her they had a great surgeon on call. "Things were moving efficiently and smoothly," she writes. "We were impressed."

Then, Weber Cascio and her husband met with the surgeon just before she was taken to the operating room. "He explained that if he didn't operate right away, I might get sepsis and die. He also said he didn't take my insurance but assured us I was in capable hands, as he was very experienced," she writes.

According to Weber Cascio, the surgeon then asked her and her husband about their occupations, and only after they answered did he tell them his fee for the operation would be $15,000.

"We were stunned by the timing and the amount," Weber Cascio writes. "But there was no time for discussion," as she was then wheeled off to surgery.

The surgery, which took no longer than 35 minutes, "went well," according to Weber Cascio. 

Then, the bill from the out-of-network surgeon arrived: $17,000 for the procedure, as well as an ED consult that Weber Cascio writes "neither my husband nor I recall."

Navigating the out-of-network bill

Weber Cascio called her insurer, which was fully covering the other hospital costs, including the ED doctors, operating room, medications, and the anesthesiologist's fee. However, she writes that, because the surgeon had no contract with the insurer, they said there was nothing they could do.

Weber Cascio estimated that the bill was more than seven times the typical out-of-network or uninsured rate for the procedure in her area, so she appealed the case to the Maryland Insurance Administration (MIA). However, while MIA was "sympathetic," Weber Cascio writes that they couldn't intervene.

Next, Weber Cascio reached out to the head of the hospital and patient relations about the bill.

"Surely the surgeon mistakenly added an extra zero? Was the hospital aware business affairs were taking place in pre-op? Can an out-of-network surgeon simply make up any fee on the spot?" she writes.

However, she never received a direct reply. Running out of options, Weber Cascio appealed her insurance company's decision. While she waited to hear back, the surgeon contacted her multiple times about the bill. "In an email exchange, he offered to reduce his fee by 30% if it would help," she writes.

A final resolution was not reached until Weber Cascio brought her bill to the Maryland attorney general's office, which contacted the hospital.

The final bill totaled $3,000, a rate that Weber Cascio writes she "felt [was] reasonable" and was still "generously above the customary rate for an uncomplicated laparoscopic appendectomy in [her] area," which was $2,330.

One surgeon's viewpoint on what went wrong

Weber Cascio later discussed the incident with a relative, who she describes as "an esteemed big-city surgeon." According to Weber Cascio, he suggested that she received such a large initial bill because "doctors and hospitals are squeezed." She writes, "Some doctors work in public hospitals by day, privately at night. Care for an uninsured burn victim, for example, can cost millions." As a result, "Everything is a balance—judgment, ethics, conscious, subconscious," Weber Cascio writes.

But telling patients to deal with the fallout by negotiating their medical charges directly with the provider "is akin to telling the victim of a mugging to ask the thief for their purse back," Weber Cascio argues. "It's uncomfortable and intimidating," and in the event of an emergency it's not always possible to have a reasoned negotiation ahead of time, Weber Cascio writes (Weber Cascio, Washington Post, 1/13).