Patients to Pay More for Out-of-Network Care

May 11, 2012 | Crandall & Pera Law
Patients to Pay More for Out-of-Network Care

The nation’s largest health insurers have been accused of manipulating out-of-network care pricing, and now they are conning patients into significantly increased costs for this very coverage, according to The New York Times.

Despite an agreement reached in 2009 to finance an objective database of doctor’s fees that patients and insurers nationally could rely on, these insurers are rapidly shifting to a calculation method based on Medicare rates, reducing reimbursement substantially since Medicare tilts its payments toward primary care, while most people go out of network for specialists.

While insurance companies defend this shift, saying exorbitant doctors’ fees are largely to blame, millions of insured families will be more vulnerable to catastrophic medical bills, even while paying higher premiums, co-payments and deductibles.

Fair Health, a new database being sought for legislation in New York, collects billions of bills from insurers to calculate a usual fee for each medical procedure in a given locality and allows consumers to compare likely out-of pocket costs.

Sandy Praeger, chairwoman of the health insurance committee of the National Association of Insurance Commissioners, said consumers are being caught in the middle of a battle between insurers demanding discounts and doctors who resist by billing more than they expect to get paid. “For some things, Medicare is really a poor payer,” she said. “So if that’s the benchmark, that just magnifies the problem.”

Read the complete details here:

Insurers Alter Cost Formula, and Patients Pay More

“This is yet another example of the billion dollar insurance industry looking for more ways to collect ever rising premiums, pay less claims and maximize payments for out-of-network care being sought by patients,” says Steve Crandall, a top rated medical malpractice attorney who has seen his fair share of patients being overcharged.

“The insurance industry dictates whom the patients can see, what the doctors can charge and what premiums they can charge to do all this,” says Crandall. “How government has stood by and allowed this to happen is one of the biggest economic and social mistakes of our generation.”

If you have any questions regarding medical malpractice throughout Ohio and Kentucky, contact Steve Crandall.