Patients pay 25% of their medical bills, AMA report shows

July 10, 2013

Patients are paying nearly one-quarter of “the amount that health insurers set aside for paying physicians,” according to the National Health Insurer Report Card from the American Medical Association (AMA).

Your patients are responsible for nearly 25% of the medical bill, according to the National Health Insurer Report Card from the American Medical Association (AMA).

The association, for the first time, analyzed direct patient expenses through copays, deductibles and coinsurance. The findings: patients are paying nearly one-quarter of “the amount that health insurers set aside for paying physicians.”

AMA Board Member Barbara L. McAneny, MD, adds, “Physicians want to provide patients with their individual out-of-pocket costs, but must work through a maze of complex insurer rules to find useful information. The AMA is calling on insurers to provide physicians with better tools that can automatically determine a patient’s payment responsibility prior to treatment.”

Some of the other findings from this year’s report card:

• Error rates dropped significantly from nearly 20% in 2010 to 7.1% in 2013. Among all payers, Medicare led the pack with an accuracy rating of 98.1%.

•  Claim denials dropped 47% in 2013, AMA says, after a spike in 2012 data for most commercial payers. The overall commercial payer denial rate dropped from 3.48% in 2012 to 1.82% in 2013. Cigna had the lowest denial rate at .54% and Medicare had the highest at 4.92%.

•  Response times for medical claims improved from 2008 to 2013, AMA reports. Humana had the fastest median response time of six days, while Aetna was the slowest at 14 days.