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Title : The Park Too Customary Controversy--Who's Cheating Whom?

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The Park Too Customary Controversy--Who's Cheating Whom?

New York AG Andrew Cuomo of late announced an investigation into how insurers pay for out-of-network services. He charged that consumers were beingness "defrauded" past times insurers who were "manipulating reimbursement rates."

Cuomo used the representative of a accuse for an constituent catch of $200 that the insurer cutting dorsum to $77--the insurer claimed the lower amount was reasonable in addition to the maximum that should last paid.

In a recent editorial, the New York Times asked, "Have health insurers been systematically cheating patients in addition to doctors of fair reimbursement for medical services?"

That is a expert question.

So, I conducted an inwards depth investigation of my own. I pulled our family's recent insurance fellowship EOBs.

I flora ane charge for an constituent visit where the physician billed our insurer $190--which our Blue Cross PPO cutting dorsum to the in-network allowable charge of $84.17. Under the PPO contract, the doc accepted the $84.17 every bit payment inwards full.

Then at that topographic point was the Quest Diagnostics accuse for my annual physical lab exam of $67.71 that the PPO cut dorsum to $11.55--which the provider accepted every bit payment inwards full. There was or in addition to then other lab test, every bit constituent of my annual physical, that had a "list price" of $223 that was cutting dorsum to $24.50 because of the network discount--which the lab likewise accepted every bit payment inwards full.

In fact, all of my annual physical lab tests were billed for a total of $477.81--which my PPO reduced to $62.70--a savings of $415.11. The lab accepted the $62.70 every bit payment inwards full.

So what does Cuomo do, he de facto calls a $200 physician accuse every bit reasonable in addition to the insurer's claim that the physician accuse actually ought to last $77 every bit "fraudulent."

I volition propose that the New York AG, in addition to his fissure investigative staff, every bit good every bit the New York Times editorial board, describe their ain insurance fellowship explanation of create goodness (EOB) forms in addition to cash inwards one's chips a dose of reality!

Thus the article The Park Too Customary Controversy--Who's Cheating Whom?

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