In 2012, Claudia Knafo, a Manhattan resident, needed spinal surgery, so she checked with multiple surgeons and eventually settled with a surgeon whose website claimed to accept her health insurance plan.
Without wasting any time, she called the doctor’s office and confirmed that he was in network. She had an appointment prior to her surgery and handed over the photocopies of her insurance cards.
She successfully underwent spinal surgery and her recovery was smooth. However, after a few weeks, she got really bad news. The website was inaccurate and the surgeon was not in the network. Plus, he had no contract with her health insurance plan.
Her health insurer mailed her a check for $66,000 to cover her spine surgery. However, the surgeon charged her $101,000 for the surgery, so he claimed additional $35,000 from her.
To make things worse, the insurer approached her again to say they had made a mistake and overpaid the surgeon. They explained to her that she needed to get $66,000 back from her doctor, who did not intend to return the money back.
Knafo said, “It felt like I was in the middle of a nuclear attack. I had the insurance coming after me for $66,000 and the doctor coming after me for $35,000. I was stuck in every hole in the system.”
She started narrating her story to insurance regulators, consumer advocacy team, and even the state attorney.
A couple of years after surgery, she traveled to Albany to request lawmakers to pass legislation to protect patients from the distressful situation that she faced.
Knafo, a professional pianist, is happy that New York passed the strongest law in the country to avert surprise medical bills. She said, “It seems so ludicrous to be a pawn between an insurance company and a hospital. Now, it really feels like I’ve at least done something good with it.”
Passing a national bill of New York’s law would solve one of the most distressing problems that people face in the U.S. health care system – high and surprising medical bills. Republicans and Democrats are working on the legislation in Congress.
However, the law will not look after the underlying cause of such a problem – sky-rocketing medical prices. Unlike Europe and Canada, where consumers are not hit by surprise medical bills, America does not regulate medical prices.
Knafo is pretty proud of the advocacy work she did to pass New York’s surprise bills law. She said, “I had all this rage, and I was able to turn it into something positive, and that was a really great feeling.”
The New York law is aiming to protect patients against surprise medical bills in situations that they cannot be expected to make informed choices about choosing their doctors. However, a scheduled surgery like Knafo’s is not covered under the law because she picked her doctor and the surprise medical bill was due to a wrong website. Unfortunately, New York does not offer her any protection.
