In 2012, a New York woman named Claudia Knafo found herself in need of a complicated spinal surgery. She immediately began the long and arduous process of selecting a physician in her insurance network, even going so far as to interview prospective surgeons to confirm their in-network status. Claudia finally selected a well-regarded local surgeon, whose website verified his in-network status with her health insurance plan, after calling his office to confirm. Weeks after her successful spinal surgery, Claudia received notice that the doctor’s receptionist and website were incorrect—the surgeon was not actually in-network. Claudia’s health insurance plan provided $66,0000 of the $101,000 value of the operation, but she still found herself saddled with a surprise medical bill of $35,000. To add insult to injury, her health insurance company later determined it had overpaid, and instructed Claudia to recover the $66,000 from her surgeon. Faced with what she describes as a “nuclear attack” from both her surgeon and insurer, Claudia began searching for help. Her story found its way to insurance regulators, consumer advocacy groups, the state attorney general’s office, and finally New York State lawmakers.
Home Run or Strike Out: Can Baseball Arbitration Solve America’s Medical Debt Crisis?,
2022 J. Disp. Resol.
Available at: https://scholarship.law.missouri.edu/jdr/vol2022/iss2/12