Most physicians of the 429,273 studied physicians in 54 specialties charged 2.5 times more than what Medicare pays them for their services in 2014, new research published by JAMA shows.
Among the physicians with the highest excess charges, 55% were anesthesiologists and 3% were in general practice, internal medicine, or family practice.
Around a third of the physicians with the highest excess charges were confined to only 10 hospital referral regions, according to the study
High excess charges can expose some patients, particularly the uninsured and those with private insurance, to unexpected medical bills. “As the health insurance market shifts toward more restrictive physician networks and high-deductible plans, protecting uninsured and out-of-network patients from high medical bills should be a policy priority,” the researchers wrote.
Around 30% of patients with private insurance received a “surprise” medical bill from 2014 through 2015, according to a Consumer Reports survey. These are mostly the result of physicians providing out-of-network services to a patient at an in-network facility and billing patients for the costs beyond what insurance will pay.
Excess charges have become a big enough problem for CMS and private payers to begin addressing it. CMS has warned that it will intervene if providers and payers don’t take steps to protect patients from excess charges and surprise medical bills. Some payers have taken the hint. UnitedHealthcare, for example, has begun reducing reimbursement for out-of-network physicians seeking excessively high reimbursement.