Argument: Private insurers limit choice of doctors as much as public insurance

Issue Report: Public health insurance option


Signe Wilkinson. “Unhealthy arguments against public option” Philadelphia Daily News. July 14, 2009: “Opponents of a public option say it will deny Americans the right to choose their own doctors. It’s true that some doctors and dentists will choose not to participate in a government-run plan. But many private insurance plans already restrict your choice of doctors by refusing to pay for treatment provided “out of network.”

In some insurance plans, you can pay extra premiums to cover “out of network” health care at a lower reimbursement – typically 80 percent of the “usual and customary reimbursement” of a treatment. But a report last month by the Senate Commerce Committee found that patients have been routinely overcharged billions of dollars in inflated fees. The database that was used to calculate reimbursements routinely understated the costs of procedures.

So consumers were forced to pay billions of dollars more in out-of-pocket expenses than they should have. If they suspected reimbursements were too low, they had no way to challenge them. Oh, and did we mention that the database was a wholly owned subsidiary of UnitedHealth Group, the nation’s second-biggest health insurer?

The Senate committee report followed an investigation by the New York State Attorney General’s Office, which ended in UnitedHealth paying $350 million plus another $50 million to create a whole new system – without admitting to any wrongdoing, of course.

Without a public option, we are trusting private insurers to fix the system that they created and are spending a far-too-healthy budget to keep in place.”