If you have health insurance, you probably know that the charges for "out of network" services are more than services provided by doctors and hospitals that are "in network." This article by Chad Terhune explains just how much the differential can be and whether the system is in need of reform. Here's an excerpt:
A Southern California surgery center charged teacher Lynne Nielsen $87,500 for a routine, 20-minute knee operation that normally costs about $3,000. Despite the huge markup, the Long Beach Unified School District and its insurer, Blue Shield of California, paid virtually all of the bill from Advanced Surgical Partners in Costa Mesa. Blue Shield mailed the $84,800 check to the high school Spanish teacher last month and told her to sign it over to the surgery center. Nielsen ... refused to send the check. Instead, she asked the California attorney general's office to investigate the matter. ... [Nielsen is] caught up in a growing battle nationwide over billing by outpatient surgery centers. Industry experts say some of these surgery centers seek out well-insured patients such as Nielsen, sometimes by waiving their copays and deductibles, and then bill their insurers exorbitant amounts for out-of-network care. All too often, critics say, insurers pay these large sums and then cite high medical bills for why insurance premiums keep rising for businesses and consumers.