Re:HHS announces rule to protect consumers from surprise med...
by crazygringo on Friday July 02, 2021 @02:56PM
(#27715364)
I'm not defending it, but there is actually a logical justification here -- it's not just insurance companies being evil.
When insurance companies sign up doctors to their network, doctors agree to lower fees (lower profit) but expect to make it up in volume, because the health plan will send them more patients.
But that only works if patients are made to stay in-network, which produces the guaranteed volume. So health care plans won't pay if you go out of network. The economics would fall apart otherwise -- plans wouldn't be able to negotiate the lower prices because a doctor's office wouldn't see any uptick in volume.
Now it depends on the plan, but there are often exceptions for when you're traveling and need emergency care -- they'll pay network rates toward that because it's not a visit that an in-network doctor would have lost.
Also, plenty of "gold-plated" plans will cover anything out-of-network as well -- because they're expensive plans they're willing to pay doctors more, and so don't need to provide doctors with volume.
When insurance companies sign up doctors to their network, doctors agree to lower fees (lower profit) but expect to make it up in volume, because the health plan will send them more patients.
But that only works if patients are made to stay in-network, which produces the guaranteed volume. So health care plans won't pay if you go out of network. The economics would fall apart otherwise -- plans wouldn't be able to negotiate the lower prices because a doctor's office wouldn't see any uptick in volume.
Now it depends on the plan, but there are often exceptions for when you're traveling and need emergency care -- they'll pay network rates toward that because it's not a visit that an in-network doctor would have lost.
Also, plenty of "gold-plated" plans will cover anything out-of-network as well -- because they're expensive plans they're willing to pay doctors more, and so don't need to provide doctors with volume.