AHIP Report: High Out-of-Network billing
A May 2009 survey of America’s Health Insurance Plan (AHIP) members collected data on various out-of-network physician billed charge amounts for claims submitted in 2008.
The survey results in Arizona showed out‐of‐network physicians billed between 670 and 1,670 percent of the Medicare fee for that service in 2008.
Some examples:
66984: Cataract surgery with insertion of artificial lens:
$ 8,691.00 billed Medicare fee: $ 618.60
27130: Total hip replacement:
$ 17,357.00 billed Medicare fee: $ 1,315.60
22612: Lower back spinal fusion:
$ 14,000 billed Medicare fee: $ 1,439.69
99244: Outpatient office consults of moderate to high severity requiring a comprehensive history, exam and moderate complexity medical decision making:
$1,190 billed Medicare fee: $ 176.83
