Archive for February 9th, 2012

Insurers Increasingly Basing Out-Of-Network Reimbursements On Medicare Rates

Thursday, February 9th, 2012

USA Today /Kaiser Health News (2/9, Appleby) discusses “a new twist” to the cost of out-of-network healthcare: “a growing number of insurers have changed the way they calculate reimbursements to shift more of the expense to patients. Now, instead of paying a percentage of the ‘usual and customary’ charges from physicians and other providers, insurers are basing reimbursements on a percentage of what Medicare pays, which can be much less.” Insurers argue that “the new approach offers greater consistency and thwarts efforts to game the system,” citing cases “‘where 98% of the physicians would charge $5,000, but some outlier would decide to charge $50,000,’ which would drive up the average.”