High prices can boost profits for health insurers: NPR

“Michael Frank ran his finger down his medical bill, studying the charges and pausing in disbelief,” Marshall Allen from ProPublica writes over at NPR’s Shots blog. “The numbers didn’t make sense. His recovery from a partial hip replacement had been difficult. He had iced and elevated his leg for weeks. He had pushed his 49-year-old body, limping and wincing, through more than a dozen physical therapy sessions. The last thing he needed was a botched bill. His December 2015 surgery to replace the ball in his left hip joint at NYU Langone Health in New York City had been routine. One night in the hospital and no complications. He was even supposed to get a deal on the cost. His insurance company, Aetna, had negotiated an in-network ‘member rate’ for him. That is the discounted price insured patients get in return for paying their premiums every month. But Frank was startled to see that Aetna had agreed to pay NYU Langone $70,000. That’s more than three times the Medicare rate for the surgery and more than double the estimate of what other insurance companies would pay for such a procedure, according to a nonprofit that tracks prices.  Fuming, Frank reached for the phone. He couldn’t see how NYU Langone could justify these fees. And what was Aetna doing? As his insurer, wasn’t its duty to represent him, its ‘member’? So why had it agreed to pay a grossly inflated rate, one that stuck him with a $7,088 bill for his portion?” Marshall Allen, Health Insurance Hustle: High Prices Can Boost Profits : Shots – Health News : NPR