Wrangling Over 'Reasonable' Fees

New York Attorney General Andrew Cuomo announced on Feb. 13 that a six-month investigation by his office found the nation's biggest health insurers have systematically defrauded consumers in the state by setting their reimbursement rates for out-of-network care artificially low. He has issued subpoenas to 16 insurers and intends to sue industry giant UnitedHealth Group.
Actuall there has been a long-simmering battle between insurers and health-care providers over how much should be paid for medical procedures. It's not just hospitals that get shortchanged by insurers. The out-of-network doctors that treat patients that come to the emergency room are routinely denied their usual and customary charges. Since most of those out-of-network doctors are in solo practice, they cannot legally collectively bargain with the insurers. So they have no recourse but to simply stop seeing patients in the emergency room. Finally, patients are caught between two warring bodies.
Insurers argue that hospitals charge for medical procedures far beyond their actual costs. Insurer say they have to compare area hospitals' rates to determine what's reasonable because health-care providers all have consultants showing them how to raise prices.
I think there is the ethic issues in it:
1. Insurers should not collect premiums when they know they don't have the contracted physicians that they need to provide adequate emergency care and yet refuse to pay the out-of-network physicians that come to bail them out.
2. health-care providers should not overcharge their patients. The overcharging proplem directly plauges the whole industry. At the end, it hurts patients.