How about a $59,000 charge for a $74 ultrasound? Who should care? Why in and out of network charges are bogus

25 Mar

Recently I wrote an article stating that one of the main problems in the health care system is the entire structure of participating and non-participating doctors, networks and the fact that such a system places the insurer as the only entity that cares about costs when in fact the two most responsible parties who should be most concerned are the patient and the health care provider.

My case has been made by a recent event involving Aetna and out of network doctors in New Jersey.  You must read this article from Bloomberg.

To get a glimpse of how ass backwards our system is, take a look at this excerpt from the article relating an older event. 

AMA Lawsuits

Aetna tried in 2007 to impose caps on some out-of-network payments, prompting doctor complaints to the New Jersey Department of Banking and Insurance. The agency sided with the doctors, fined the company $2.5 million, and ordered it to pay out-of-network practitioners enough so that patients wouldn’t be asked to pay balances other than co-pays.

In 2009, Aetna, UnitedHealth Group Inc. (UNH), Cigna Corp. (CI) and WellPoint Inc. (WLP) were accused by the New York attorney general of underpaying out-of-network physicians by manipulating a database used to calculate payments. They paid a total of $90 million in settlements without admitting wrongdoing. UnitedHealthcare agreed that year to pay $350 million to settle a lawsuit by the American Medical Association over the same issues. Similar AMA lawsuits against Aetna, Cigna and Wellpoint are pending. 

“So patients wouldn’t be asked to pay balances other than co-pays”

If the insurer imposed caps on out of network payments to doctors who are not in the network because they charge high fees, the patient would be responsible, yikes we can’t have that .  Rather, we force the insurer to pay the high fee and wonder why premiums keep rising and why most consumers don’t give a hoot what their health care costs.


Do you still think the problem is those darn insurance companies?

How many Americans do you think would side with the doctors and say that the insurance company should pay what the doctors charge?   Waaaaaay too many!

One Response to “How about a $59,000 charge for a $74 ultrasound? Who should care? Why in and out of network charges are bogus”

  1. Scoutmagazine March 25, 2011 at 4:02 PM #

    I have been saying that all the time we are shooting messenger. The only people trying to control cost ae insurance companies. The doctors and hospitals are the problem. Who do you think can lower the health care cost? Not the insurance company…But The Democrats and Obama have put the finger on the wrong group. It is not politicaly correct ot say that the doctors and hospitals charge too much or lower the amount charged. The doctors and hospitals are charging too much so point the finger at them.


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