It’s been a couple of months since New York Attorney General Andrew Cuomo, scourge of the health insurers, has caused me to address the sorry state of the Empire State’s political direction on health reform. Last time, I expressed concern (and perhaps a little contrition) that I was too hard on doctors and too accomodating to 3rd party payers.
Well, here we go again…..
Mr. Cuomo is upset at how much UnitedHealth Group, which owns a company that aggregates claims data to determine “usual and customary charges”, ratchets down doctors’ invoice-prices to said “usual and customary charges”. According to the example, an out-of-network doctor charges $200 for a visit, the insurer re-calculates the “usual and customary” charge to be $77, and pays 80 percent of the latter – $62. The doctor chases the patient for the remaining $138. It’s an unpleasant surprise for the patient, to be sure.
However, the attorney general’s “inquiry” attacking UnitedHealth Group for “underpaying” claims from out-of-network providers is breathtakingly one-sided. Cuomo declares, correctly, that there is no “transparency”, but this starts at the doctor’s office. Did any of the patients in question ask the doctor, up front, what the visit would cost? More than likely, they passively handed over their card from their out-of-network insurer and let the medical bureaucracy churn out the claim.
In reality, the only way most of us can get price transparency from doctors is to identify ourselves as uninsured and offer to pay by cash, check, or credit card at the time of service. In such cases, I have no doubt that the price would be closer to $77 dollars than $200.
By no means am I saying that health plans are faultless in the fiasco of price opacity in which American health care finds itself. Nevertheless, by what right does any health care provider claim payment from a patient who has not agreed to a price beforehand? Other professionals at least define an hourly or project rate. States need to review their laws on provider payments, find all those that contain the term “usual and customary charge” and throw them out!