America's Health Insurance Plans, the trade group representing the health insurance industry, feels it has been unfairly vilified by the Administration as the villains of the healthcare system during its efforts to push through a health reform initiative. In an effort to strike back, the group today released a survey citing what it says are examples of medical fees gone wild, data that apparently suggests that health insurers are in no way the key problem facing the health system under reform.
The survey looked at 10 companies insuring patients in the 30 most populous U.S. states, and asked companies to supply some of the highest bills from those states issued during 2008. Researchers excluded charges that were greater than 10,000 percent of Medicare's fees for a procedure or more than 2,000 percent of Medicare's fees, and also more than 50 percent higher than the next-highest bill for the same procedure. Still, many very high bills remained.
Among the reasons AHIP looked for high bills was to isolate cases when consumers were stuck with extremely high, out-of-network bills when providers refused to accept the insurer's allowance and charged the patient the entire balance. For example, it cited cases such as one given by the New York Health Plan Association, which, at a state hearing, told of a Long Island surgeon who charged $23,500 for an emergency appendectomy, was paid $4,629 by the insurance company, then demanded the balance from the health plan or said he'd get it from the patient. The health plan paid.
To learn more about this issue:
- read this piece from The New York Times (reg. req.)