Web site to show out-of-network costs

A stethoscope resting on a laptop.

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.

About the author

Nancy Marshall-Genzer is a senior reporter for Marketplace based in Washington, D.C. covering daily news.

Comments

I agree to American Public Media's Terms and Conditions.
With Generous Support From...