PhotoRight now, the biggest controversy in the healthcare field is the price of prescription medications. Politicians from Elizabeth Warren to Donald Trump have blasted them as being too high.

What often escapes notice is the cost of seeing an out-of-network specialist, but researchers at Johns Hopkins, writing in JAMA, say privately-insured consumers are often blindsided with huge bills from these providers.

When you choose a provider, you likely do a little research, especially making sure the provider accepts your health insurance. When you see internists, family doctors, or psychiatrists, you have some choice in the matter and have a way to control costs.

But the Hopkins medical and business school researchers, who looked at cases where patients were treated by out-of-network providers, found a huge difference in costs.

Emergency situations

In many cases, patients have no choice in the matter because the situation is an emergency. They don't have time to find an in-network provider.

In those cases, the researchers found the average anesthesiologist charged six times what Medicare pays. An emergency room doctor charged four times more.

As the study points out, these charges don't just affect the uninsured, but also the well-covered when they see physicians out of their insurer’s network. Yes, you probably expect to pay more if you have to go out-of-network, but the researchers say patients are often shocked at how much more it costs.

“The doctors with the highest markups are often the ones that patients don’t actually choose,” said Gerard F. Anderson, PhD, a professor in the Department of Health Policy and Management at the Bloomberg School and the study's lead author.

Bill shock

What happens, he says, is two months later the patient gets a bill from a doctor he or she never really met. In nearly every case, he says, the price is outrageous.

While the numbers are based on a national average, the researchers note that distinct geographic variations exist. For example, doctors in Wisconsin have almost twice the markup of doctors in neighboring Michigan. The largest mark-ups were for anesthesiologists.

What's especially infuriating, the researchers say, is when patients deliberately select a hospital and physician that are in their insurance network, only to learn after-the-fact that one or more of the doctors was out-of-network and outrageously expensive.

What's the remedy? The researchers say Congress should require physicians to disclose their network status to each patient before delivering the service. It would also improve transparency, they say, if doctors were required to post out-of-network prices.


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