New Report Examines Physician Out-of-Network Charges
For Immediate Release
February 1, 2013
Contact:
Susan Pisano
202-778-3245
Exorbitant Fees
Represent a Hidden Threat to Affordability
Washington,
D.C.
– A new report
from America’s Health Insurance Plans (AHIP) highlighting data collected by
Dyckman & Associates 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 found that some physicians who do not take insurance are charging
patients startling fees for a wide variety of medical treatments and
services. Click here
to view a new infographic highlighting the findings of this report.
This
report demonstrates the importance of public policy leaders focusing on how
much patients who seek out-of-network care are being charged by some
physicians. 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. The report is an update to a
previous analysis by Dyckman & Associates released in 2009. Because the
billing practices of some physicians continue to be an impediment to
affordability for consumers, AHIP asked them to update their analysis last
year.
The
findings of the report should cause policymakers to closely investigate this
issue, especially considering how these charges compare to in-network fees, as
well as fees charged for similar services in other countries. 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.
While
the issue of how much is appropriate for out-of-network physicians to charge
has not been part of the affordability discussion to date, this report
demonstrates that it needs to be. No mechanism exists to protect patients who
seek care out-of-network from receiving bills that are unreasonable and
unaffordable.
“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,” said
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.”
Health
plans create physician networks to ensure that patients have affordable access
to a wide choice of high-quality health care providers. Consumers receive
savings when they visit contracted providers who have agreed to lower rates,
and are generally prohibited from charging patients anything above that rate.
Consumers who receive services from in-network providers also typically have
lower cost sharing, which, over the decades, has saved billions of dollars in
out-of-pocket costs and premiums.
(click thumbnail to view larger image)
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