Kaiser Health News staff writer Julie Appleby warns readers the potential problems of seeking “out-of-network” health care.
Consumers Hit By Higher Out-of-Network Medical Costs
When Sharon Smith chose an out-of-network specialist to perform a complicated jaw surgery on her teenage son last May, she knew it would cost her more. But she was not expecting a $15,000 difference.
Consumers have long complained about the cost of going outside their health plan’s network, but Smith encountered a new twist: a growing number of insurers have changed the way they calculate reimbursements to shift more of the expense to patients.
Now, instead of paying a percentage of the “usual and customary” charges from physicians and other providers, insurers are basing reimbursements on a percentage of what Medicare pays, which can be much less. “Every carrier is moving to this,” says Ken Sperling, global health care practice leader at the benefit consulting firm Aon Hewitt.