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Web site to show out-of-network costs
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TEXT OF STORY
Kai Ryssdal: There's health-care news you can use today. Not from the halls of Congress, but from the desk of New York State Attorney General Andrew Cuomo. Today Cuomo announced a new Web site and database for consumers who use doctors outside their insurance network. You take your chances when you do that -- go out of network because it's not always so easy to tell how much of money you're going to be on the hook for. Marketplace's Nancy Marshall Genzer explains.
NANCY MARSHALL GENZER: Mary Reinbold-Jerome was diagnosed with ovarian cancer in 2006. Her doctor told her to go a hospital that was out of network. Reinbold Jerome knew she'd have to pay more, because her doctor was not on her health plan. But she wasn't expecting $80,000 in medical bills.
MARY REINBOLD-JEROME: I just wept. It just devastated me, almost more than the cancer.
Reinbold-Jerome's insurance company had said it would pay 80 percent of what's known as usual and customary for her out-of-network care. She thought her share would amount to a few thousand dollars. But what her insurance company considered usual and customary was much lower than what she was charged. In fact, her insurance company owned the firm that set those usual and customary rates.
Reinbold-Jerome complained to New York Attorney General Andrew Cuomo. The result? A new, neutral nonprofit that will develop its own database of usual and customary rates. Consumers will be able to access the database, and compare rates.
Duke University health policy professor Chris Conover says the database will help consumers better manage their own care.
CHRIS CONOVER: A lot of American consumers have a built-in suspicion about private insurers, and whether they're always acting in their best interest.
Alan Sager teaches health policy at Boston University. He says the new database is a start, but it won't help everyone.
ALAN SAGER: Many people don't have the time, in the midst of an illness or other medical crisis, to use an on-Web resource. So some patients will be helped, some families will be helped, others absolutely will not.
Thirteen insurance companies have agreed to use the new database to set out-of-network rates. It's expected to be up and running by next summer.
In Washington, I'm Nancy Marshall Genzer for Marketplace.
What is the URL for Cuomo's "new Web site and database for consumers who use doctors outside their insurance network"? I don't see it on his website. His FAQ says "... FAIR Health and the upstate research network will design a new consumer web site ..." so maybe it's not up yet?
Unfortunately, Genzer only told 1/4 of the story. What drove Cuomo in 2008 was the revelation that Ingenix, who was "cooking" the Reasonable & Customary charge data, is a wholly owned subsidiary of United HealthCare and was colluding with Aetna, WellPoint (owner of 14 different for-profit Blue Cross / Blue Shields), Cigna amongst others. Nor was this the first time Ingenix was sued: the AMA sued in 2000 for exactly the same reason.
As both a consumer and provider, I have wondered for years why almost every R&C was lower than almost any one I knew of.
This whole subject of reimbursement has been a point of contention for years. In the 1950-70s, the California Medical Association studied charges, and was sued in 1978 for Antitrust and possible fee-setting. However, the Harvard School of Public Health picked this up for the Medicare Resource-Based Relative Value Study (RB-RVS), and clearly the health insurers did too, as they have been exempt from Antitrust regulations since 1945 under the McCarran-Ferguson Act.
