The study was based on 18 billion health claims for 97 types of the most common services in 50 states, and released Thursday by America's Health Insurance Plans, the industry trade group.
Nationally, the study found that the average out-of-network charge for neck/spin disk surgery was $10,459, or nearly 640 percent higher than the $1,414 paid by Medicare. And a 40-minute office outpatient visit would cost a patient an average of $260 from an out-of-network doctor, whereas that same doctor would receive $147 if Medicare was paying for the visit.
The majority of procedures, 57 out of the 97 analyzed, had average out-of-network billed charges of 300 percent or higher compared with Medicare reimbursement rates for the same services, AHIP said.
The study found examples of procedures, such as in New Jersey, where patients who sought treatment outside of the provider network covered by their plans were charged an average of 1,200 percent more than Medicare for an ultrasonic guide for a biopsy, and in New York where patients getting low-back disc surgery from an out-of-network provider would be charged 1,100 percent more than Medicare.
Knee surgeries, which are among the most common operations performed in the United States, on average cost more than 500 percent above the Medicare reimbursement rate in Rhode Island if obtained out of network.