AMA Says Patients Now Paying Nearly A Quarter Of Costs
The average insured patient is now responsible for nearly a quarter of their bill, according to a new survey by the American Medical Association.
The Chicago-based AMA's new health insurer report card concluded that during February and March of this year, the average insured consumer was responsible for 23.6 percent of the amount carriers paid their providers.
The out-of-pocket averages differed between insurers. They ranged from 15% for enrollees in Humana plans, up to 29.2% for those enrolled in Health Care Service Corp.
Two large insurers located in the Midwest, Indianapolis-based Anthem and Minnesota-based UnitedHealth, had out-of-pocket rates averaging 23.1% and 23.4%, respectively. By comparison, Medicare's average out-of-pocket rates were 24.6%.
Moreover, the study concluded that patients are also burdened with a maze of insurer regulations before they can obtain their actual out-of-pocket costs. The association, which represents a large bulk of the nation's 900,000 physicians, believes that up to $12 billion a year could be saved if they presented consumers with clearer rules.
“Physicians want to provide patients with their individual out-of-pocket costs, but must work through a maze of complex insurer rules to find useful information,” said Barbara L. McAneny, M.D., an AMA board member. “The AMA is calling on insurers to provide physicians with better tools that can automatically determine a patient’s payment responsibility prior to treatment.”
The AMA also released its first-ever administrative burden index, based on the percentage of claims requiring rework and resubmissions by payers. UnitedHealth had the lowest rate, with 5.4% of claims needing rework. Regence Health Care, a Blues plan that operates in Utah and the Pacific Northwest, had the highest rework rate, 20.5%. The average rework rate was 10.75%. Each reworked claim cost an average of $2.23 before resubmission.
The AMA has set a goal of having each claim paid within 30 days of submission.
