Report from insurers criticizes out-of-network provider charges

The national trade association for health insurance plans released a report today that is critical of providers charging much higher rates for out-of-network patients (Source: "Report Faults High Fees for Out-of-Network Care," New York Times, Feb. 1, 2013)

According to the report from America's Health Insurance Plans, some providers charge out-of-network patients rates that are 30, 40 or nearly 100 times greater than Medicare reimbursement rates.

“When you’re out of network, it’s a blank check,” said Karen Ignagni, president and chief executive of AHIP. “The consumer is vulnerable to ‘anything goes.’ ”

In response to the insurers’ report, the American Medical Association noted on Thursday that a recent analysis found that doctors’ services account for just 16 percent of health care costs.

“There are outliers in every profession, in every business,” said Dr. Andrew Y. Kleinman, a plastic surgeon who is vice president of the Medical Society of the State of New York.

Ignagni said the high costs sometimes charged to out-of-network patients could impact how many people enroll for coverage under the ACA. “Unless we deal with cost, we won’t have affordability,” she said. “And unless we have affordability, we won’t have people participating” under the Affordable Care Act.