Overbilling And Out-Of-Network Care Contribute To Marketplace Tension

News outlets examine what providers charge for surgical care.

The New York Times: Report Faults High Fees For Out-Of-Network Care
Though he was living on $18,000 a year as a graduate student, [Angel] Gonzalez had good insurance and the hospital, St. Charles in Port Jefferson, N.Y., was in his network. But the surgeon who came in to remove Mr. Gonzalez’s gallbladder that Sunday night was not. He billed Mr. Gonzalez $30,000, and an assistant billed an additional $30,000. ... A health insurance industry report to be released on Friday highlights the exorbitant fees charged by some doctors to out-of-network patients like Mr. Gonzalez. The report, by America's Health Insurance Plans, or AHIP, contrasts some of the highest bills charged by non-network providers in 30 states with Medicare rates for the same services. Some of the charges, the insurers assert, are 30, 40 or nearly 100 times greater than Medicare rates (Rabin, 1/31).

Meanwhile --

Los Angeles Times: Small Surgeries, Huge Markups
Nationwide, some insurers have begun to challenge these bills from outpatient centers. Last year, a unit of insurance giant Aetna Inc. sued several surgery centers in Northern California and accused them of overbilling the insurer more than $20 million. It has pursued similar actions against providers in New Jersey and Texas. Other insurers such as UnitedHealth Group Inc. have filed similar suits in California (Terhune, 1/31).

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