A report commissioned by America’s Health Insurance Plans claims some physicians who don't participate in health insurance networks are charging fees that are several times higher than Medicare reimbursement for the same service in the same geographic area.
The report, prepared for AHIP by Dyckman and Associates, looked at the 30 largest states and found that some physicians who don’t take insurance are charging patients startling fees for a wide variety of medical treatments and services.
Recent public policy discussions about out-of-network services have focused only on how much insurers pay for these services, and AHIP says the critical issue of what out-of-network physicians are charging patients has been ignored.
“What we found should cause policymakers to closely investigate this issue, including looking carefully at how these charges compare to in-network fees, as well as fees charged for similar services in other countries,” said AHIP officials.
In one state, a physician billed a patient $6,791 for “cataract surgery with insertion of artificial lens” – more than 11 times the Medicare fee of $581. Similar incidents were found in all 30 states, AHIP says, and there are many examples of even higher charges.
No mechanism exists to protect patients who seek care out-of-network care from receiving bills that are unreasonable and unaffordable, says AHIP President and CEO Karen Ignagni.
“As policymakers pursue healthcare reform, we encourage them to look at how much is being charged for services, particularly since higher charges don’t mean high quality of care,” said Ignagni. “With the nation facing the crushing burden of rising medical costs, all stakeholders should be focusing on constructive ways to bring costs under control.”