Insurers Pass the Buck

Tired of being the punching bag for health care reformists, the insurance industry is showing it has some fight left in it.

A report pointing the finger at doctors for high health care costs is just one way the insurance industry is trying to use its own data to show that there is more than one culprit in the system driving up costs. Large insurers, including UnitedHealth Group, are studying how doctors, hospitals and drug companies contribute to the soaring cost of care.

"What you're seeing is an industry responding with real data," says Tony Plohoros, a New Jersey-based consultant who works with insurers, drug companies and other health providers. "Insurance providers can make a data-driven argument because they have it."

A report by the trade group America's Health Insurance Plans released today looks at billing practices of docs in 30 states and found that physicians working outside insurance networks charge patients exorbitant prices for many routine procedures.

In numerous cases, the doctors charged amounts that were thousands of times higher than rates set by Medicare, the government's health plan for the elderly.

Some examples: In New York, a physician charged almost $30,000 for a gastrointestinal exam that the government says should cost $389. A doctor in California charged more than $20,000 for a knee surgery that Medicare determined to cost $585.

Susan Pisano, a spokeswoman for the trade group, says insurers have been talking about the discrepancy in doctors' charges for some time and "it's important to inform the public with these discussions."

The insurance industry is being painted by President Obama and Democrats in Congress as public enemy No. 1 for problems with the health care system and runaway costs. While trade groups for the drug and hospital industries have struck deals with the Democrats promising they'll cut costs from the system, the insurance industry has yet to find a seat at the bargaining table.

The largest doctors' group in the nation, the American Medical Association, also is in good graces of President Obama after endorsing his health reform plan.

In a statement, J. James Rohack, the president of the doctors group, slammed the report, saying it "focuses on the most extreme outliers of the billions of health insurance claims filed annually. To call this representative of the entire physician community is grossly misleading."