Insurers Hit Back At Doctor Charges

You think your health insurer slaps you with some wild charges? Well, the insurers say take a look at what comes our way from some doctors.

The trade group America's Health Insurance Plans released results of a survey of high charges submitted by doctors outside the insurers' approved networks of physicians last year. The snapshot, says AHIP, shows the value of the networks of providers and negotiated rates that insurers put together.

There are some doozies, even after the group says it screened out some of the highest charges that might have been submitted in error.

How about a hip replacement in Arizona for which the doctor charged $17,357 compared with the Medicare fee of $1315.60. Or, take a look at a pricey gallbladder surgery in Colorado: doctor's charge $26,100 versus the usual Medicare fee of $625.94.

 

The insurers gave the New York Times a copy of the report before it was posted online Tuesday, because "they felt unfairly vilified," the paper reported. They also said the results show that doctors' fees are part of the health-care cost problem.

The snapshot of charges is anecdotal, however. And the insurance industry has a rather spotty record in dealing with out-of-network charges. New York Attorney General Andrew Cuomo has wrested big settlements from a bunch of insurers he claimed lowballed payments to out-of-network doctors by using a database of benchmark charges that was artificially low.

The problem of consumers is that they usually wind up on the hook for the balance of charges that an insurer doesn't pay an out-of-network doctor.

Princeton health economist Uwe Reinhardt told the Times the situation is absurd."You worry about credit card charges, you scream for consumer protection — why not scream for it here?" he said.