AHIP Criticizes 'Exorbitant' Out-of-Network Charges

John Commins, for HealthLeaders Media , August 12, 2009

The health insurance industry's trade group wants state and federal policymakers to examine what it claims are "exorbitant" out-of-network charges by physicians that are detailed in an industry-sponsored survey released today.

The America's Health Insurance Plans report, a survey of physician out-of-network charges in the 30 largest states, found what AHIP claims are wide disparities in the cost of various services that were in some cases tenfold higher than Medicare reimbursements for the same service in the same area. Susan Pisano, AHIP vice president for communications, calls the figures "pretty startling."

"It is important for this to be in the public domain simply because there is nothing from preventing somebody from charging that much. You basically can charge whatever you want," says Pisano.

The survey's release comes one day after President Obama leveled blistering criticism at the private health insurance industry at a town hall meeting in Portsmouth, NH. The president told a clapping, cheering crowd that "right now we have a healthcare system that too often works better for the insurance industry than it does for the American people. And we've got to change that."

Pisano rejects suggestions that AHIP's new report was an attempt to deflect the negative publicity from the president's broadsides.

"Certainly, we have been publicly vilified, but there are bigger questions here," she says. "We've been having a lot of discussion about how much health plans pay doctors. We've been having a lot of discussions about what the appropriate levels are for out-of-pocket costs and cost-sharing limits for consumers. What we haven't been having a discussion about is what is being charged. If we are going to be having thoughtful policy discussions, we need to have all of that information. So far, it's been all from one perspective. What do you think that says about the discussion?"

Pisano says AHIP hired Dyckman & Associations, the Washington, D.C.-based consultants, to compile the survey after hearing repeated complaints from its members about exorbitant out-of-network charges. She says the survey findings should prompt state and federal policymakers to investigate out-of-network charges and compare them with in-network charges, as well as fees charged for similar services in other countries.

In one state, the survey found, a physician billed a patient $6,791 for "cataract surgery with insertion of artificial lens" more than 1,100% of the Medicare fee of $581. Pisano says similar examples were found in all 30 states, and there are many examples of even higher variation in charges. She says the survey was "conservative," did not cherry pick egregious examples, and had been purged of dubious or extreme outliers.

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