New research shows that some physicians who choose not to participate in health insurance networks are charging patients fees that are 10 times—and in some cases, nearly 100 times—Medicare reimbursement for the same service in the same geographic area. Looking at the 30 largest states, the report by America's Health Insurance Plans found that some physicians who don't take insurance are charging patients startling fees for a wide variety of medical treatments and services.
Insurers hope to spotlight the continuing problem they say the Patient Protection and Affordable Care Act does little to address. They say in discussions to date, the focus only has been on how much insurers pay for these services, and the critical issue of what out-of-network physicians charge patients has been ignored, AHIP reports.
"As we shine a spotlight on the affordability issue, we encourage policymakers to look at how much is being charged for services, particularly since there is often no relationship between higher charges and higher quality of care," says AHIP President and CEO Karen 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."
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For example, in New York, a physician billed a patient $115,625 for lumbar spinal fusion— 62 times the Medicare fee of $1,867. Similar examples were found in all 30 states included in the survey, and there are many examples of even higher variations in charges, despite the fact that the researchers used a conservative approach in reporting the data, AHIP researchers say.
Many of the highest billers were in New York, Texas, Florida and New Jersey.
"When out-of-network providers are given a 'blank check' to charge whatever they want, it drives up the cost of coverage and leaves patients with extremely high medical bills," the report reads.
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