Tuesday, February 26, 2008

Give Cuomo and the Physicians What They Say They Want--Show the Patient Just What the Doc Is Accepting From Everyone Else

New York Attorney General Andrew Cuomo says that health plans are using the "Prevailing Healthcare Charges System" to "defraud" consumers and "manipulate" the system.

He points to the example of an insurer refusing to pay a physician's $200 bill--the insurer said that $77 was more appropriate.

In an earlier post, I pointed out that an examination of my own family's health insurance "explanation of benefits" statements from our insurer found a $190 office visit that was reduced to $84.17 by my insurer--which the doctor accepted as payment in full. Then there were the lab tests for my own annual physical that were reduced from the lab's charge of $478 to $63--which the lab also accepted as payment in full.

So why not give Cuomo and the docs what they say they want--a truthful and straightforward accounting of the system? Why not release to any consumer who asks for it a detailing of what their doctor is charging, and accepting, from everyone else?

What better "transparency" then seeing what your doctor is really willing to take.

The doctor with that $200 charge, to the consumer who found himself out-of-network, can then be the one doing the explaining when it becomes clear that about 90% of the time he takes more like $80 for the same thing.

There is that old saying about being careful that you don't get what you wish for.

Recent Post: The Usual and Customary Controversy--Who's Cheating Whom?
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