Out-of-Network Payments Falling to Medicare Levels in Some States

Payments to out-of-network providers by Blue Cross plans in Texas and Illinois, by UnitedHealth Group in New York and by Aetna for some policies are dropping to Medicare levels, no longer honoring the providers' "usual, customary and reasonable" rates, according to a report by American Medical News.

 

A spokeswoman for Health Care Service Corp., parent of Blues plans in Texas, Illinois, New Mexico and Oklahoma, said implementation dates for the Medicare rates would vary depending on the state and individual products. The company insisted "this is not necessarily a savings across the board, but rather a consistent, transparent methodology that is widely recognized by the provider community." It added: "In some cases, reimbursement may be higher than before."

The Medical Society of the State of New York, reported that United's subsidiary in that state has been changing many of its policies, particularly those with small businesses, to Medicare levels for out-of-network payments. However, a UnitedHealth Group spokeswoman said there had been no systematic change.

And an Aetna spokeswoman said the company had shifted to Medicare levels for out-of-network payments in some of its policies. "This is one of a number of benefit changes in these economically challenging times to help keep premium increases in check," she said.

Read the American Medical News report on out-of-network payments.

Read more coverage of out-of-network payments:

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