Kaiser Health News/USA Today has a story on out network charges and what it means for patients. As employers and individuals seek ways to lower costs, health plans are working to provide critical information on provider costs and quality. One of the issues on the cost front is what some out-of-network providers will charge patients. The article actually references an AHIP survey that examined this exact issue.
From the article:
“A 2009 survey of doctor charges in 30 states by the industry’s lobby group, America’s Health Insurance Plans, found prices for some common procedures ranged to up to 10 times what Medicare sets as payment. Some out-of-network hip surgeons, Muney says, charge 30 times what Medicare pays: ‘Does the patient think that’s OK?’”
More from the AHIP survey:
“Some out‐of‐network providers are charging exorbitant prices – several hundred or even over a thousand percent of the Medicare reimbursement for the same service in the same area. Recent examples: $4,500 for an office visit when Medicare would have paid $134; $14,400 for removal of a gallbladder when Medicare would have paid $656; and $40,000 for a total hip replacement when Medicare would have paid $1,558.”
