Everyone expects healthcare to be expensive, but facing new cutbacks and regulations, the industry continues to astound. The New York Times released a shocking expose on some of the more insidious practices employed by providers to recoup lost revenue, but perhaps the most brazen example is Peter Drier, who was charged $117,000 by an “assistant surgeon” he never even met.

“I thought I understood the risks,” Mr. Drier, who lives in New York City, said later. “But this was just so wrong — I had no choice and no negotiating power.”

Many of these high-priced charges amount to appearance fees. When recovering from surgery, for example, a patient may receive visits from a whole host of doctors and specialists – some of whom are “consulted” under spurious circumstances, and all of whom at least try to charge as much as possible for popping in to ask if a patient’s ok.

“The notion is you can make end runs around price controls by increasing the number of things you do and bill for,” said Dr. Darshak Sanghavi, a health policy expert at the Brookings Institution until recently.

Even more confounding is the way insurers are cut out of the loop. Earlier, knowing that doctors and hospitals would charge high markups for services in anticipation of pushback, they could negotiate lower rates. Now, because adjusters aren’t present in operating rooms and can’t know for sure the nature of a consultation, they have significantly less power in the negotiation process.

In the case of a physician belonging to an out of network insurance provider, the fees can become astronomical. That’s what happened to Mr. Drier, who’s “assistant surgeon’s” role could have been filled by a resident, nurse or physicians assistant, all of whom do not add to the cost of a procedure.

Other times, doctors are called in to assess emergency room patients when nurses and residents (who do not charge fees for their services) would suffice. Using contractors to provide services previously included in hospital care also serves as a convenient way to jack up fees.

What’s worse, some insurers’ decision to pay the asking price in the interest of their customers only serves to encourage the gouging.