Usual and Customary

Today's New York Times featured an article I've been waiting to see for a long time. Andrew Cuomo, Attorney General of the State of New York, has ordered UnitedHealth Systems to review its database of "usual and customary fees" covered for non-network charges on health insurance costs. The normal procedure, as we all know, is that in-network physicians and institutions have agreed to accept a certain fee for procedures, tests, and office visits; patients are encouraged to go to in-network resources so that the agreed-upon fees will apply, thus saving the insurance company a great deal of money. If a patient chooses a non-network provider, then the patient is responsible for the difference between what the provider charges and the "usual and customary fee". Cuomo alleges that the UnitedHealth database is consistently low-balling the costs, so that the penalty for using a non-network provider is a great financial burden to the patient. The UnitedHealth database is used by nearly all insurance companies as the basis for these costs. It's an interesting concept and I certainly understand the motivation behind it; the "in-network" relationship works well both for the insurance company and the health service provider.

But what happens when the patient has no choice in the matter? All of the local anaesthesiologists are non-network providers, for example. I paid $800 for the anaesthesiologist attending my nephrectomy - what choice would I have had, between undergoing emergency surgery at another hospital, or not having anaesthesia for the operation? Likewise, my lifeflighted trip from the local hospital to OSU was hardly something I had a choice in; I made it to ICU with literally minutes to spare before dying. Was I to have waited for some other helicopter with medical staff to show up? And who determines a "reasonable" cost for emergency transport under those circumstances - what comparable costs can you call for? That $5300 bill was worth it too, so far as I'm concerned, but it's hard for most people to come up with such a sum on short notice. I still keep a reserve in savings for that reason. Anyway, I'll be interested to see what happens with Cuomo's orders.

For the sixth straight week, Saint H will be spending at least one night in Columbus due to weather. Right now it's snowing (4" on the ground); we're supposed to get another 4" tomorrow followed by blizzard conditions. I may not see him until Friday at this rate. Oh well, I have lots of movies to watch ...