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Health Insurers Highlight Excessive Out-of-Network Charges
Some California physicians providing out-of-network medical care bill patients at rates far beyond what Medicare allows, a new report from a health insurance trade group shows.The national survey released Friday by America's Health Insurance Plans is part of the industry's effort to show that some medical providers are overcharging consumers and unnecessarily raising healthcare costs. Some critics fault insurers for all too often paying these excessive charges for out-of-network care and then passing along those increased costs in the form of higher premiums for employers and consumers.
In California, the report shows, a pathologist billed $8,100 for a tissue exam in 2011, compared with the Medicare fee of $128.46. Another California doctor billed $30,000 for a gallbladder removal using a laparoscope while the Medicare rate was $778.16, according the industry group.
Read the full story: http://lat.ms/WZ25ZT
Source: Los Angeles Times
Managed Care Reflections: A Q&A With A. Mark Fendrick, MD, and Michael E. Chernew, PhD
December 2nd 2025To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The December issue features a conversation with AJMC Co–Editors in Chief A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design and a professor at the University of Michigan in Ann Arbor; and Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and the director of the Healthcare Markets and Regulation Lab at Harvard Medical School in Boston, Massachusetts.
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