by Kumud B. Jindal, MD, MPH

Many patients and self-appointed health care experts view medical services as commodities, and openly express frustration with seemingly opaque pricing for a visit to the doctor’s office. “Doctors should publish their fees so we know what we’re paying!” The idea that this matters significantly with regard to health care costs is a terrible myth, one that deserves much closer scrutiny.

The health insurance industry and our legislators have successfully made it a violation of anti-trust laws for me to discuss my payments from Aetna, for example, with other internists in my area. Since I must “charge” every payer the same for a given service, naturally, like any business, I will set my fee a little higher than the best known payer in my area.

So, if for a typical office visit Medicare pays $80, and other insurances pay me $35 to $70, it makes sense for me to “charge” everyone $85 even though I will only get this amount from cash-paying patients. In fact, charging different amounts to different payers is considered insurance fraud; this includes waiving co-pays and discounting fees for cash-paying uninsured patients.

For your doctor’s office to display a list of fees is completely irrelevant to the issue of health care costs. What is relevant, and should be more commonly understood, is that insurance companies set payment rates unilaterally, disallow communication among doctors of those rates, and therefore are able to legally discriminate against smaller practices. This is a widespread common practice in New York. The only recourse I have in dealing with an under-paying insurer is to stop seeing their patients. Since I have been in practice, only Medicare has increased fees, and even this is well short of inflation.

I encourage anyone to examine their Explanation of Benefits statement after their next primary care doctor visit, and compare what was charged with what was actually paid. Then compare what was paid to the total annual premiums collected by their insurer. Hopefully they they will understand what a tiny fraction of their health care dollars actually goes to their doctor, why insurance company executives often take home 8- and 9-figure incomes, and why insurers don’t really want transparency, or at least want to mislead the public that their doctor is “overcharging” rather than the fact that they are underpaying.

Kumud Jindal is an internal medicine physician.

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