Sunday, October 12, 2014

Tendon surgery sheds light on the lack of clarity in some out-of-network pricing

By Steven Pearlstein Columnist October 10 WashPost

In the health care business these days, it’s all about the networks.

Spurred on by competition on the new Affordable Care Act exchanges, health insurers are moving to pare down their provider networks, promising participating hospitals and doctors more patients in exchange for lower payments.

Docs are busy selling out their practices to hospitals that can negotiate better rates for their services, giving up their independence to become salaried hospital employees.

And together, hospitals and large medical groups are joining “accountable care” networks in which, like insurers, they agree to provide all of a family’s medical needs for a fixed annual fee.

It’s one reason — perhaps a big reason — why medical costs have begun to level off in recent years.

But it’s not without its trade-offs. Lower rates and higher volumes at hospitals and doctors’ offices often translate into inferior service for patients — longer waits, rushed appointments, less help from the staff. And if you find yourself outside the network, it’s apt to be very expensive, whether you intended to go out of network or not.

(More here.)

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