Insurers Alter Cost Formula, and Patients Pay More

[MachineGhost]

Despite a landmark settlement that was expected to increase coverage for out-of-network care, the nation’s largest health insurers have been switching to a new payment method that in most cases significantly increases the cost to the patient.

The settlement, reached in 2009, followed New York State’s accusation that the companies  manipulated data they used to price such care, shortchanging the nation’s patients by hundreds of millions of dollars.

The agreement required the companies to finance an objective database of doctors’ fees that patients and insurers nationally could rely on. Gov. Andrew M. Cuomo, then the attorney general, said it would increase reimbursements by as much as 28 percent.

It has not turned out that way. Though the settlement required the companies to underwrite the new database with $95 million, it did not obligate them to use it. So by the time the database was finally up and running last year, the same companies, across the country, were rapidly shifting to another calculation method, based on Medicare rates, that usually reduces reimbursement substantially.

http://www.nytimes.com/2012/04/24/nyreg ... .html?_r=1

[Pointedstick]

Sometimes I wonder when doctors are going to stop accepting Medicare or even insurance at all. I'd imagine any clinic that offered up a big table of prices for every service so that people knew what they were going to pay would do fairly well for themselves. They could cut out the entire billing, insurance, and medicare reimbursement departments!

I think Wal-Mart has actually done something like that, but I've never visited one of their clinics so I'm not sure how successful they've been.