Dive Brief:
- A recent insurance industry analysis by America's Health Insurance Plans (AHIP) discovered large differences among providers for the same treatments as well as geographic differences. California had the largest gap between out-of-network and Medicare rates: 626% higher for an out-of-network brain MRI than Medicare. New York providers charged 1,100% more than Medicare for low back disc surgery and emergency care in Florida cost 700% higher for out-of-network care.
- The report is based on 18 billion claims and cover 100 medical procedures performed in 2013 and 2014 in all states.
- However, Dr. Steven Stack, president of the AMA, said in a statement the report was "grossly misleading," and featured a few extreme examples in comparison to Medicare payments that do not reflect inflation. He also pointed to insurance companies increasing costs saying, "If there is a growing problem with out-of-network billing, it's because the insurance industry has created it with ever more restrictive provider networks."
Dive Insight:
Claire Krusing, a spokeswoman for AHIP, said the report shows "there is more work to be done and that we have to fix this problem for patients. There needs to be much more disclosure from hospitals and doctors and specialists."
Betsy Imholz, director of special projects for the Consumers Union agreed providers are charging too much, but added "providers will take whatever they can get. If there's no limitation...they will ask for the most they can." Many patients, she added, are unaware some healthcare expenses are out-of-network until they receive a bill.
Some states, like New York, have passed laws protecting patients from being hit with higher out-of-pocket bills. California recently failed to pass a similar law.