A 59-year-old New Jersey man was billed more than $700,000 after having complex spine surgery following a vehicle crash, exposing gaps between how auto and health insurers pay for medical treatments, Kaiser Health News reported April 22.
Mark Gottlieb suffered damage to four vertebrae in his upper spine, along with six smashed teeth when a driver crashed into his car in January 2019. He was receiving care at Paramus, N.J.-based Bergen Pain Management Clinic and had an outpatient anterior cervical discectomy and fusion April 3, 2020, at Secaucus, N.J.-based Hudson Regional Hospital after pain from the crash persisted.
Mr. Gottlieb had $250,000 in medical costs covered by his Geico car insurance and has health insurance through Aetna. However, for those hurt in vehicle crashes, car insurance providers are the ones primarily responsible for negotiating and paying the insurance portion of medical bills. Since auto insurers generally don't have broad medical provider networks, many patients are out of network. Oftentimes, auto insurers will end up paying more for some services than health insurers.
This left Mr. Gottlieb with a bill about eight times as high as what Medicare would pay. The hospital charged $445,995 for the surgery, and the pain management center charged $264,444 for the main surgeon.
"That is an outrageously high surgeon's fee for this type of surgery," North American Spine Society President Eeric Truumees, MD, told Kaiser Health News. "I do a tremendous amount of complex cervical spine surgery and never had a fee that high even for complex surgery that takes 10 hours."
Although Geico reduced some of those charges, Medicare would have paid about $29,500 for Mr. Gottlieb's entire procedure, with $1,800 going to the surgeon, according to researchers.
Now, Mr. Gottlieb is still unclear if Bergen Pain Management will seek a remaining $89,000 for his bill. He sued the driver who caused the crash and won a settlement; that money is being saved for future medical needs. Mr. Gottlieb also filed complaints about his bills with state regulators, lawmakers and his insurers, but an Aetna investigation didn't find "further need for action," a spokesperson told Kaiser Health News.