AHIP (America’s Health Insurance Plans) explains why private insurance is a bad deal

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http://pnhp.org/blog/


"...While the issue of how much is appropriate for out-of-network physicians to charge has not been part of health reform discussion to date, this report demonstrates that it needs to be. No mechanism exists to protect patients who seek care out-of-network from receiving bills that are unreasonable and unaffordable.

“As policymakers pursue health care reform, we encourage them to look at how much is being charged for services, particularly since higher charges don’t mean high quality of care,” said AHIP President and CEO Karen Ignagni. “With the nation facing the crushing burden of rising medical costs, all stakeholders should be focusing on constructive ways to bring costs under control.”


As we look at comprehensive health care reform, we really have to ask ourselves just what is it that the private insurance plans are providing us in exchange for their exorbitantly high administrative costs and the costly administrative burden they place on the health care delivery system?

....So we already have the heavy hand of government administering price controls. But isn’t that what AHIP is not so subtly advocating? GOVERNMENT PRICE CONTROLS for those providers who refuse to sign their private insurance contracts! If the government is going to control prices anyway, then why would we need or even want the private insurance contracts?

BusinessWeek’s statement this past week that the health insurers have already won should not be accepted as a given, but should be considered a challenge to us to demand, in loud and clear terms, the reform that we need. Let’s make it a very hot August for our representatives in Congress, but let’s make our message effective by being polite while we generate heat."



New Report Examines Out-of-Network Charges by Some Physicians

AHIP Urges Policymakers to Explore this Issue

http://www.ahip.org/content/pressrelease.aspx?docid=28028

"Washington, D. C. – A new report by Dyckman & Associates prepared for America’s Health Insurance Plans shows that some physicians who choose not to participate in health insurance networks are charging patients fees that are several hundred – and in some cases, a thousand percent - higher than Medicare reimbursement for the same service in the same geographic area. Looking at the 30 largest states, the report found that some physicians who don’t take insurance are charging patients startling fees for a wide variety of medical treatments and services.

Recently, in public policy discussions about out-of-network services, the focus has been only on how much insurers pay for these services, and the critical issue of what out-of-network physicians are charging patients has been ignored. Hearing from its members about exorbitant out-of-network charges, AHIP engaged Dyckman & Associates to gather information across the country.

What we found should cause policymakers to closely investigate this issue, including looking carefully at how these charges compare to in-network fees, as well as fees charged for similar services in other countries. For example, in one state, a physician billed a patient $6,791 for “cataract surgery with insertion of artificial lens” – over 1100% of the Medicare fee of $581. Similar examples were found in all 30 states, and there are many examples of even higher variation in charges, even though the researchers used a conservative approach to the data that excluded outliers.

While the issue of how much is appropriate for out-of-network physicians to charge has not been part of health reform discussion to date, this report demonstrates that it needs to be. No mechanism exists to protect patients who seek care out-of-network from receiving bills that are unreasonable and unaffordable..."

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1. Thanks for the rec :) n/t