Out-of-network healthcare costs called 'exorbitant'

Health Care and Health Insurance
by Chris Merkel

Over the past several years, there has obviously been a lot of attention paid to the ways in which consumers are able to afford their health care overall. With the various rules of the Patient Protection and Affordable Care Act that are now in place, many people have access to low-cost treatments in a majority of cases. That is not, however, likely to be an issue when they occasionally have to go out of their coverage network.

When it comes to visits with non-network care providers and specialists, the average cost sharing for the insured is about 300 percent more, according to a report from America's Health Insurance Plans. However, some consumers might pay as little as about 118 percent more, to as much as nearly 1,400 percent more than if they'd gone to an in-network care provider for the same treatments. AHIP president and CEO Marilyn Tavenner noted that affordability problems such as these create massive barriers to health care for millions of Americans, and that out-of-network costs - while sometimes unavoidable - are also likely to be too massive to reasonably bear for most people even when they have health insurance.

What's the difference?
The ways in which these additional costs are levied can obviously vary sharply from one care provider to the next, and even changes by state, the report said. For instance, consumers who are on Medicare and get an ultrasonic guide for a biopsy in New Jersey would pay more than 1,200 percent of the fee they'd have been charged if they went to an in-network care provider. And in New York state, patients who get low back disc surgery will usually pay as much as 1,100 percent more when going out-of-network.

Similarly, Floridians on Medicare typically paid 700 percent more than normal when they get emergency care, the report said. And in Rhode Island, knee surgeries cost 500 percent more out-of-network. Often, these come as a result of "surprise" charges that are levied later in the billing process, which can certainly catch consumers off-guard.

Part of a worrisome trend
Of course, the real reason this is a major problem in the health care industry these days is that consumers are routinely seeing the network of doctors to which they have access shrink as employers and other insurance providers look to shore up bottom lines and keep coverage as affordable as possible, the report said. Even if they're not dealing with drastically declining network sizes, people are typically seeing the percentage of the health care costs they cover increase, meaning that in either event it's probably getting more expensive to get the same care they once did.

This is certainly an issue that health insurance companies might need to do a little more to deal with going forward, as excessive costs for unexpected treatments could end up putting their policyholders in significant financial peril, and potentially hurt the insurers' bottom lines as time goes on.