Health care providers in the South may be hiking up prices more for emergency care and critical care than for colon cancer detection and radiation therapy.
Analysts at America’s Health Insurance Plans (AHIP) have raised that possibility with state-by-state health care cost data they have published in a look at gaps between what providers bill privately insured out-of-network (OON) patients and what they bill Medicare enrollees.
AHIP created the cost report to draw policymakers’ attention to differences between what similar providers in different parts of the United States charge for the same procedure, and the differences between what patients with different types of health coverage pay for the same procedure.
The AHIP analysts calculated the typical gap between what the providers in a state charge OON patients for seven procedures and what they charge Medicare patients for the same procedures. For each procedure, the analysts used the OON-to-Medicare billing ratios to break states into three categories: states with relatively small gaps between the OON bills and the Medicare bills; states with medium-big gaps; and states with large gaps.
For a high-intensity emergency department visit, for example, a state was in the low-biller category if its providers charged OON patients less than 422 percent of what they charged Medicare enrollees. A state ranked in the high-biller category if its providers’ OON-to-Medicare billing ratio was over 516 percent.
For MRIs of the brain, the OON-to-Medicare ratio cut-off for making it into the low-biller category was 644 percent. In the states in the high-biller category, the providers’ OON-to-Medicare ratio was over 806 percent.