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New York Union Blames Out-of-Network Doctors for Millions in Costs - Bloomberg

“That raised a question for us as to whether there has been, implicitly or explictly, a business decision by Northwell to allow doctors to be out-of-network and to bill at really high rates,” Rothstein said. Northwell insists the answer is no. Outside doctors that have admitting privileges at Northwell bill the health plan separately and aren’t authorized to use Northwell’s name on their bills, Aviles said. “Legally we can’t tell another corporation what to do and how much to bill,” Aviles said. The union health fund said a handful of provider groups accounted for a disproportionate share of the  out-of-network bills. It declined to identify those groups but one provider-group billed 100% of its claims at Northwell as out-of-network, according to 32BJ.