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Out-of-network costs out of control

New research shows that some physicians who choose not to participate in health insurance networks are charging patients fees that are 10 timesand in some cases, nearly 100 timesMedicare reimbursement for the same service in the same geographic area.

By Kathryn Mayer | Updated on February 04, 2013

New research shows that 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. Looking at the 30 largest states, the report by America’s Health Insurance Plans found that some physicians who don’t take insurance are charging patients startling fees for a wide variety of medical treatments and services.

Insurers hope to spotlight the continuing problem they say the Patient Protection and Affordable Care Act does little to address. They say in discussions to date, the focus only has been on how much insurers pay for these services, and the critical issue of what out-of-network physicians charge patients has been ignored, AHIP reports.

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