Posts Tagged ‘out-of-network fees’

Infographic: Patient Out-of-Network Fees

October 28th, 2015 by Melanie Matthews

Patients who seek care from out-of-network providers or specialists, see, on average, potential excess charges of 300 percent compared to Medicare’s fee for the same treatment or procedure, according to a new infographic by AHIP.

The infographic compares the out-of-network charge for 10 healthcare encounters compared with the Medicare payment for that service.

Patient Out-of-Network Fees

Narrow networks—for both medical and pharmacy providers—are gradually becoming more accepted by carriers, plan sponsors and patients. Smaller provider networks allow payers to manage overall healthcare costs while still maintaining access to benefits—an important consideration as plan designs become more commoditized in the age of public and private health insurance exchanges.

Narrow Network Strategies and Trends for Health Plans and PBMs outlines the tactics health plans are using to restrict medical and pharmacy networks while still maintaining adequate access to care and positive relationships with providers. It also summarizes case studies of health plans and PBMs that have formed narrow networks and the results they’ve seen.

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Infographic: Physician Out-of-Network Charges

February 11th, 2013 by Melanie Matthews

Some physicians who choose not to participate in health insurance networks are charging patients fees that are 10 times – and in some cases, nearly 100 times – Medicare reimbursement for the same service in the same geographic area, according to a new report from America’s Health Insurance Plans (AHIP) highlighting data collected by Dyckman & Associates.

Looking at the 30 largest states, the report found that some physicians who do not take insurance are charging patients startling fees for a wide variety of medical treatments and services illustrated in this new infographic by AHIP.

Physician Out-of-Network Charges

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You may also be interested in this related resource: Practice Management STATS Quick Reference – 10 Specialties Edition.