Plans And Providers Clash Over Fee Data

In the real world, many health account holders are just starting to get health account debit cards, the GAO researchers write.

In a typical case, a provider may submit a claim to the insurer after seeing the patient. The insurer may take as long as 6 weeks to tell the patient what the repriced bill will be, the researchers write.

“During this time period, the patient, who may incur other health care expenses, is left uncertain of the amount that will be withdrawn from the HSA, and therefore cannot determine the remaining balance,” the researchers observe.

The CDHP insurers told GAO researchers that “physician-specific cost and quality data would be difficult to collect and report until the physician community agreed that the value of providing these kinds of information to customers outweighed any potentially negative personal ramifications,” the researchers write.

Meanwhile, the American Medical Association, Chicago, has published a draft report suggesting that insurers may be at least partly to blame for the lack of price data.

One key problem is that physicians have no way to know how insurers will reprice claims, the authors of the AMA draft note.

Because of uncertainty about insurance payments, “it is very difficult, if not impossible, for the physician to provide the patient with information about the patient’s out-of-pocket cost for a service or procedure,” the authors write.

AMA members also worry that “negotiated price” databases may leave out information about contract terms that reduce the amounts insurers actually pay physicians.

A copy of the GAO report is on the Web at Document Link