The report from America’s Health Insurance Plans released Friday analyzed out-of-network charges for more than 18 billion private health insurance claims.
Some of the findings include:
- Patients that underwent low back disc surgery faced potential excess charges averaging more than 2,300 percent of the Medicare fee.
- Charges for cervical/thoracic spinal injections averaged more than 2,100 percent of the Medicare fee for the same procedure.
- Knee surgeries incurred charges averaging more than 1,600 percent of the Medicare fee.
- Some patients seeking ultrasonic guidance for biopsies saw potential excess charges averaging more than 1,200 percent of the Medicare fee.
“Improving access to health care requires us to fundamentally address the barriers to affordability, including the excessive prices charged for medical services,” AHIP CEO and President Marilyn Tavenner said. “This latest report demonstrates the serious cost pressures facing consumers who want affordable access to care and the added financial burden caused by soaring out-of-network medical bills.”
Less than a month ago, a report from the NJ for Health Care coalition, in partnership with Consumers Union, detailed the ways in which health care consumers can unknowingly arrange for out-of-network services, only to be blindsided later on by a potentially hefty bill that is not covered by their providers.
Both reports provide adequate support for pending legislation, sponsored by Assemblymen Troy Singleton (D-Mount Laurel), Gary Schaer (D-Passaic) and Craig Coughlin (D-Woodbridge) and state Sen. Joseph Vitale (D-Woodbridge), which aims to protect consumers from surprise out-of-network bills and cap out-of-network billing.
“It is still on the front burner and we need to keep it there. We want to try and get something done in this term, and not go beyond that,” Coughlin said in an interview with NJBIZ.
“I realize that this is a zero sum game. If we are saving $92 million, someone is not making $92 million. (Opponents’) concerns are legitimate, and we will try to address them as best as we can. But we have to try and achieve a method of controlling health care costs,” he said. “I’m not in the business of putting hospitals out of business who are providing health care to the people when it’s critical, so we have to balance the equities.”
“We have created a bill that is going to be able to get bipartisan support because it protects consumers,” Coughlin said, adding that many of his Republican colleagues have agreed to get on board.
For more on the study, click here.