Canadian physicians are also not laboring under debt loads as high as US physicians, so there is less debt pressure on them to do ethically dubious things to find money to pay their debt.
Compare Canadian medical school tuition (in Canadian dollars; as of the date of this post, CAD$1 is about USD$0.76):
https://afmc.ca/node/247
to US medical school tuition:
https://www.aamc.org/data-reports/reporting-tools/report/tuition-and-student-fees-reports
Actually, I don’t think most insurance companies would have cut the $25,000 check in the first place. My experience over the years was being nickel and dimed by the insurance company over small stuff – between UCR (“usual and customary rate”) and the insurance companies opinion of what is “medically necessary” – I think in that circumstance I would have a EOB showing the insurance was paying about $15 for the single test they deemed appropriate and that the rest of the stuff was on the patient. I guess the patient in NY must have had one of those “cadillac” plans.
I did have a situation once where the bill went through to the insurance company after my daughter’s birth that included an entirely unrelated bill for a totally unrelated procedure for a different patient with the same surname as mine., and was paid in full immediately. I did alert the insurance company. (Though it may not have mattered, because for all I know the other similarly-named patient might have had the same insurance company — so the company could have been on the hook either way.) So mistakes do happen, but I’d think an out-of-network lab bill for $25K would draw attention.
I just can’t wrap my brain around what would have cost so much. For $25k, the lab could have sequenced the entire patient’s genome… several times - which would have been absolutely unnecessary.
Perhaps the insurance company has decided that, as a matter of policy, not to get into “rationing” fights against (usually) both the patient and provider and just pass the costs along to the payer (either the employer directly if the plan is self-funded, or the employer indirectly through higher premiums at the next renewal for a non-self-funded plan). “Rationing” fights cause insurance companies to be seen as the villains in the medical care system; since the money really is someone else’s money (particularly in self-funded plans) with the insurance company just taking a fee for administrative services, the incentive may be just to pay out of someone else money, spend less on the administration for more profit for itself, and not be a villain.
“unrelated bill for a totally unrelated procedure for a different patient with the same surname” - That happened to us … $10k charged (for DD, who was not even on that trip with us) when DH only had a blood test done.
All genetic testing require prior authorization, mainly because of the high cost. Most labs won’t even process the blood without that prior authorization or without making the patient aware of the cost upfront. That is my experience in dealing with these cases. This story is very unusual.
Genetic testing has its own risks because it may disclose a propensity for a condition that could affect patient insurance rates as well. This is a very odd situation and story—hopefully uncommon.