Kentucky doctors want to know what insurers pay

The Kentucky Medical Assn. is asking insurers to post their rates, but so far the companies aren't agreeing to do that.

By Cheryl Jackson, amednews staff. May 21, 2001.

Physicians in Kentucky, through the state's medical association, are asking insurers to post their fee schedules.

"We want them to post what they are going to pay physicians for the services they render," said William Monnig, MD, chair of the Kentucky Medical Assn.'s managed care committee and president of The Urology Group, a 32-physician group based in Edgewood, Ky.

It's not a new complaint. But the need for such postings is growing as physicians find themselves dealing with more plans, Dr. Monnig said. "Our overhead keeps increasing. The price they pay for the services either decreases or is not keeping up within inflation. And it gets to a point where we need to know whether we can actually provide the services."

"It gets more and more complicated as they keep offering more different types of plans. ... And they all have different fee schedules," he said.

The medical association has contacted major insurers to get the information, though, in most cases, they've been met with a standard reaction. Insurers typically reiterate that they allow physicians to ask about a limited number of procedures, then tell them how much they will pay for those procedures or services.

That's too much of a hassle for physicians, the group said.

"When we get a check from insurance company XYZ for $62, I don't know if that's the right amount or the wrong amount," said Dr. Monnig. "If you end up requesting that information for every insurance company you do business with, it takes a lot of work on the part of the individual doctors, whereas the company could easily publish it and make it accessible."

It's a process particularly cumbersome for doctors in solo practice, he said. "The administrative cost of obtaining that information is too high."

Aetna, though, has suggested that the state group post on its Web site, or link to, the Medicare reimbursement rates, as that is the basis for the insurer's fees, said Patrick Padgett, staff counsel for the KMA.

"My thought is that as physicians and others have an opportunity to utilize public benchmark figures, it will make it easier for physicians," said David Allen, MD, Aetna's Kentucky network medical director.

The physicians group is considering that suggestion. But a problem with going that route is that insurers use different versions from different years of the Medicare schedule.

"Then other insurance companies come along and say they don't use it at all," Dr. Monnig said. "It is an administrative nightmare to figure out how much I should be getting paid."