Hidden fees plague consumers and insurers

Doctors and hospitals are increasingly charging consumers and their health insurance companies "hidden fees"--and they're blaming the Affordable Care Act. 

"In our industry, all fees are hidden," Shaun Green, chief operating officer of Arches Health Plan in Salt Lake City, told FierceHealthPayer in an email this morning.

"It's probably easier to get into the FBI confidential files than to see a hospital charge master. We should know the price of a procedure before we do it," added Green, who is a FierceHealthPayer Editorial Advisory Board member. 

Providers say the Affordable Care Act makes it harder to collect on bills, because it shifts so much of the payment responsibility from insurers to patients. To make up for it, providers are "forced" to charge extra for some services, Cindy Weston of the American Billing Association, an industry group, told The New York Times.

Payers can get stuck with the bill for dubious charges. For instance, orthopedic clinics charge patients to put an arm in a cast, known as a separate refraction fee, on top of the usual cost for the office visit, reports The Times. Another patient was charged for an ER visit even though the procedure was scheduled in advance. 

And a New Jersey provision requires that insurers pay for emergency treatment at hospitals and facilities where their coverage is not accepted. This has caused providers to hike up costs of certain services, knowing the insurer will be left with the bill. 

Even though the ACA provides guidance on what types of services must be covered at no cost, "if a provider chooses to do something beyond what's covered, there may be charges," Clare Krusing, a spokeswoman for America's Health Insurance Plans, told The Times.

What's more, concealing costs of healthcare services prevents competition based on price and value, according a previous Center for American Progress issue brief, FierceHealthPayer previously reported. Lack of price transparency is becoming a widespread concern when consumers receive scheduled care.

For more:
- here's the NYT article