New state-by-state report examines charges billed by out-of-network physicians
America's Health Insurance Plans (AHIP) has released a report outlining the charges billed by out-of-network physicians in the 30 largest states by population. The report, The Value of Provider Networks and the Role of Out-of-Network Provider Charges in Rising Health Care Costs, is designed to illustrate the value of provider networks and a growing problem faced by consumers who want affordable, meaningful access to out-of-network providers, according to AHIP.
For example, the report lists fees billed and Medicare-allowed charges for lower-back spinal fusion in a variety of states, including these:
- In New York, out-of-network physicians billed $46,250, or 2,669% of the $1,732.36 allowed Medicare charge;
- In California, out-of-network physicians billed $36,000, or 2,143% of the $1,680.24 allowed Medicare charge;
- In Connecticut, out-of-network physicians billed $26,881, or 1,709% of the $1,572.95 allowed Medicare charge;
- In Illinois, out-of-network physicians billed $19,065, or 1,329% of the $1,434.08 allowed Medicare charge; and
- In North Carolina, out-of-network physicians billed $13,957, or 1,025% of the $1,361.47 allowed Medicare charge.
According to the report, Consumers who are charged exorbitant fees by out-of-network providers incur additional costs because the protection against balance billing generally does not extend to services provided out-of-network. This detracts from the ability of health plans to offer affordable access to out-of-network providers for those consumers who want the advantages of a network, but also maintain the option to go out-of-network if they choose.
Insurers typically reimburse for services from out-of-network providers at a significantly lower rate than they reimburse network providers. In addition, out-of-network providers are not bound by contract to accept an insurer's reimbursement as payment in full.
As policymakers pursue health care reform, we encourage them to look at how much is being charged for services, particularly since higher charges don’t mean high 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.
The survey was conducted for AHIP by Dyckman & Associates, a Washington, D.C.-based firm specializing in health care consulting and litigation support services for the health care industry. For more information, visit http://www.ahipresearch.org/ValueofProviderNetworksSurvey.html.
Reprinted with permission. © CCH
(Submitted Aug. 18, 2009)
<p>New state by state report examines charges billed by out of network physicians America's Health Insurance Plans (AHIP) has released a report outlining the charges billed by out of network physicians in the 30 largest states by population. The report,</p>
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