Report: Health providers charge sky-high out-of-network fees
Many patients receiving care from out-of-network providers or specialists in Iowa face exorbitant charges for medical services, according to a new report from America’s Health Insurance Plans, a national trade association representing insurers.
Health plans and patients routinely receive charges from out-of-network providers that range from 195 to 868 percent of the amount paid by Medicare for the same services, according to the report.
The report presents the most comprehensive analysis to date on out-of-network charges based on FAIR Health Inc.’s private health insurance database of more than 18 billion claims. The findings underscore the affordability challenges facing millions of Americans, particularly when patients face “surprise” bills from out-of-network doctors and clinicians, the association said in a release.
The findings underscore the value that health plans’ provider networks provide by selectively contracting with credentialed providers, AHIP said. However, when providers choose not to participate in a health plan’s network or do not meet requirements for participation, consumers have little protection against physicians who “balance bill” or charge the cost difference for a particular service.
The AHIP report found that in Iowa:
- Some patients seeking emergency care out of their insurer’s network faced potential excess charges averaging more than 300 percent of the Medicare fee.
- Patients who underwent an hour of chemotherapy saw potential charges averaging more than 200 percent of the Medicare fee.
- Ultrasonic guidance for biopsies incurred excess charges averaging more than 600 percent of the Medicare fee.
“Improving access to health care requires us to fundamentally address the barriers to affordability, including the excessive prices charged for medical services,” AHIP President and CEO Marilyn Tavenner said. “This latest report demonstrates the serious cost pressures facing consumers who want affordable access to care and the added financial burden caused by soaring out-of-network medical bills.”
A separate study conducted by health plan shopping site HealthPocket Inc. found that nearly half of Affordable Care Act plans on HealthCare.gov lack easily accessible out-of-network coverage. Nationally, 47 percent of marketplace plans on the HealthCare.gov marketplace had out-of-network coverage. In Iowa, 35 percent of plans offered on Healthcare.gov did not provide out-of-network coverage.
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