AHIP President & CEO – Karen Ignagni
Some physicians who don’t participate in health insurance networks are charging patients 10 times the Medicare reimbursement for the same service in the same geographic area. In some cases, they charge nearly 100 times more, according to a report from America’s Health Insurance Plans (AHIP).
For example, in New York, a physician billed a patient $115,625 for lumbar spinal fusion, which is 62 times the Medicare fee of $1,867. Similar examples were found in all 30 states and there are many examples of even higher variations in charges. The report is based on data gathered from Dyckman & Associates
AHIP says that public policy discussions focus how much insurers pay for these services while ignoring what out-of-network physicians are charging patients. AHIP wants policymakers to look at how these charges compare to in-network fees as well as fees charged for similar services in other countries.
AHIP President and CEO Karen Ignagni notes that consumers who get services from in-network providers usually have lower cost sharing, which has saved billions of dollars in out-of-pocket costs and premiums over the decades. For more information, visit www.ahip.org.
