KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Intracacies Of Doctors’ Fees Difficult To Unravel

"For the most part, doctor fees are a mystery. If people see a doctor who is part of their insurance network, they are responsible only for deductibles and co-payments, and the price the health insurer pays is often a secret," The New York Times reports. "And if people see a doctor outside their network, they usually have no idea what the charge will be - even though they are responsible for most of it - until the bill comes."

Some experts say health reform efforts should include limits on charges for out-of-network health services, something which is not addressed in current legislation. One suggestion is using legislation to encourage people to stay in their networks, a behavior that will help avoid high costs that can lead to medical bankruptcy. Another is restricting the charges – which are negotiated down by insurance companies within networks – to 150 percent of Medicare payments, for example.

Out-of-network, charges can soar as high as $26,000 for a gall bladder surgery for which Medicare pays only $681, according to an insurance industry trade group. However, doctor's fees vary within networks, too. According to one doctor whose Website attempts to reveal what insurers have negotiated with doctors, the arranged prices in San Franscisco range from $700 to $7,000 (Kolata, 8/18).

Related coverage by KHN: Code Blue: Out-Of-Network Charges Can Spur Financial Emergency

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