Patients Face High Costs for Out-of-Network Care, AHIP Survey Finds
Patients who seek treatment for routine medical care from out-of-network physicians often are charged very high rates, according to a survey from America's Health Insurance Plans, the New York Times reports.
According to the Times, the study aims to counter criticism from the Obama administration and reform advocates that some elements of the insurance industry are contributing to the problems in the U.S. health care system.
For the study, the insurance lobby group examined some of the highest bills that 10 if its member companies in 30 of the most populous states received in 2008. The group used Medicare payments as a comparison; Medicare payments are on average 80% of what private insurers pay.
In one case, the survey found that a patient in Illinois was charged $12,712 for cataract surgery out-of-network, while the same procedure would have cost $675 under Medicare. In another case, a California patient was charged $20,120 for a knee operation for which Medicare would have paid $584, while a New Jersey patient had a $72,000 bill for a spinal fusion procedure that Medicare would cover for $1,629, the study found.
AHIP said it did not have data on the frequency of such high-fee charges.
The Times reports that some reform proposals in Congress would require insurers to disclose to beneficiaries the potential cost of out-of-network care, but there are no specific proposals that address the prices charged by out-of-network providers.
AHIP President and CEO Karen Ignagni said, "As we think about the health care debate, what's been talked about is, 'What are the cost-sharing levels? What are the premium levels? How much do health plans pay?' No politician has asked how much is being charged."
Robert Wah -- a spokesperson for the American Medical Association -- said that physicians who have contracts with insurers often are paid very little or face difficulties receiving payments, prompting some to cease their association with insurance plans. That, he said, leads to the extra costs from out-of-network care (Kolata, New York Times, 8/12).
AHIP Grassroots Campaign Drums Up Industry Support
The Campaign for an American Solution -- a grassroots operation run by AHIP -- is attempting to bolster the insurance industry's message during the health reform debate "at a time when Democrats have turned their rhetoric against health insurers," Roll Call reports.
According to Roll Call, the campaign has distributed talking points to employees of AHIP's 1,300 member companies, policyholders and others who share the group's goals for reform.
The campaign also has compiled a comprehensive list of scheduled town-hall forums and other health reform-related events nationwide and offered guidelines on how participants should conduct themselves during the events (Ackley, Roll Call, 8/12).