Some doctors charge sky-high fees when they treat out-of-network patients.
America’s Health Insurance Plans, Washington, discusses that problem in a response to criticism of health insurer use of pricing databases to determine reasonable rates for out-of-network-care.
AHIP hired outside researchers to gather examples of what it believes to be outrageous claims submitted by out-of-network doctors.
In one state, for example, “a physician billed a patient $6,791 for ‘cataract surgery with insertion of artificial lens,’” AHIP says.
That total is more than 11 times the standard Medicare rate for insertion of an artificial lens, AHIP reports.
“Similar examples were found in all 30 states, and there are many examples of even higher variation in charges, even though the researchers used a conservative approach to the data that excluded outliers,” AHIP says.
Today, the major health system change proposals have not yet included mechanisms for protecting patients and insurers from unreasonable out-of-network bills, AHIP says.