America’s Health Insurance Plans (AHIP) has released a report—prepared by Dyckman & Associates—showing that some physicians are charging patients “startling fees” for a wide variety of medical treatments and services received out-of-network.
The report found that some physicians who choose not to participate in health insurance networks are charging patients fees that are several hundred, and in some cases, several thousand percent higher than Medicare reimbursement for similar treatments in the same geographical areas.
Dyckman collected and analyzed the results of a survey of member plans to identify the highest billed charges in 2008 from out-of-network physicians in the 30 largest states. For example, a Texas physician billed a patient $12,000 for an upper GI endoscopic diagnostic exam with biopsy—3,550 percent more than the Medicare fee of $337.99 for comparable service. In Ohio, one physician charged a patient $10,307.09 for a minimally invasive knee meniscus surgery—1,792 percent higher than the Medicare fee of $575.17.
The findings confirmed the need for appropriate out-of-network physician charges to be part of the healthcare reform debate, according to AHIP.
“As policymakers pursue healthcare 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.”