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New Report Spotlights Excessive Out-of-Network Medical Bills


  05:01:05 pm, by MedBen5   , 254 words,  
Categories: News, Health Plan Management

New Report Spotlights Excessive Out-of-Network Medical Bills

The New York Times looks at a report on the high cost of out-of-network health care, released today by the national trade association for the health insurance industry:

“The report, by America’s Health Insurance Plans, or AHIP, contrasts some of the highest bills charged by non-network providers in 30 states with Medicare rates for the same services. Some of the charges, the insurers assert, are 30, 40 or nearly 100 times greater than Medicare rates.

“Insurers hope to spotlight a vexing problem that they say the Affordable Care Act does little to address. ‘When you’re out of network, it’s a blank check,’ said Karen Ignagni, president and chief executive of AHIP. ‘The consumer is vulnerable to ‘anything goes.’’

“‘Unless we deal with cost, we won’t have affordability,’ she added. ‘And unless we have affordability, we won’t have people participating’ under the Affordable Care Act.

“Among the fees on the report’s list are a $6,205 outpatient office visit to a doctor in Massachusetts for which Medicare would have paid $152; a $12,000 bill for examining a tissue specimen in New York for which Medicare would have paid $128; and a $48,983 surgeon’s fee for a total hip replacement in New Jersey that Medicare would have reimbursed at $1,543. Many of the highest billers were in New York, Texas, Florida and New Jersey.”

In response, doctors said the report focuses on isolated cases of overcharging, and that their services account for less than one-fifth of health care costs. Read the complete story at the NYT website.

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