Concerns About A.D.H.D. Practices and Amphetamine Addiction

Before his addiction, Richard Fee was a popular college class president and aspiring medical student. "You keep giving Adderall to my son, you're going to kill him," said Rick Fee, Richard's father, to one of his son's doctors.

VIRGINIA BEACH — Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

Andrea Mohin/The New York Times

MENTAL HEALTH CLINIC Dominion Psychiatric Associates in Virginia Beach, where Richard Fee was treated by Dr. Waldo M. Ellison. After observing Richard and hearing his complaints about concentration, Dr. Ellison diagnosed attention deficit hyperactivity disorder and prescribed the stimulant Adderall.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard’s own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that A.D.H.D. practices can fail patients, particularly young adults. “We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered,” said Dr. Parker, a psychiatrist in Virginia Beach. “I think it’s an abnegation of trust. The public needs to say this is totally unacceptable and walk out.”

Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors.

“Any step along the way, someone could have helped him — they were just handing out drugs,” said Richard’s father. Emphasizing that he had no intention of bringing legal action against any of the doctors involved, Mr. Fee said: “People have to know that kids are out there getting these drugs and getting addicted to them. And doctors are helping them do it.”

“...when he was in elementary school he fidgeted, daydreamed and got A’s. he has been an A-B student until mid college when he became scattered and he wandered while reading He never had to study. Presently without medication, his mind thinks most of the time, he procrastinated, he multitasks not finishing in a timely manner.”

Dr. Waldo M. Ellison

Richard Fee initial evaluation

Feb. 5, 2010

Richard began acting strangely soon after moving back home in late 2009, his parents said. He stayed up for days at a time, went from gregarious to grumpy and back, and scrawled compulsively in notebooks. His father, while trying to add Richard to his health insurance policy, learned that he was taking Vyvanse for A.D.H.D.

Richard explained to him that he had been having trouble concentrating while studying for medical school entrance exams the previous year and that he had seen a doctor and received a diagnosis. His father reacted with surprise. Richard had never shown any A.D.H.D. symptoms his entire life, from nursery school through high school, when he was awarded a full academic scholarship to Greensboro College in North Carolina. Mr. Fee also expressed concerns about the safety of his son’s taking daily amphetamines for a condition he might not have.

“The doctor wouldn’t give me anything that’s bad for me,” Mr. Fee recalled his son saying that day. “I’m not buying it on the street corner.”

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Never too early to plan for college expenses

Look at your cute baby, and imagine the little tyke wearing a high school cap and gown about 17 years from now.

Picturing the child holding a diploma, when he or she can't even hold a rattle yet, is probably next to impossible. But that day will come. And if you are like most parents, as you watch junior walk across the stage to pick up a diploma, you will be vacillating between feelings of pride and utter fear. At that point, your child will be headed to college, and the price tag will be so shocking you'll be tossing and turning at night.

If college prices continue to climb as they have the past few years, by the time today's newborns go to college, the sticker price will be about $37,700 for one year of tuition, room and board at a state university and $98,200 at a private college, said Kalman Chany, a college financial aid consultant and author of "Paying for College Without Going Broke." For a four-year education, it will be about $161,500 at a university in your state or $426,400 at a private college, he estimates. To put that into perspective, many public colleges now run about $20,000 a year, and some private colleges are more than $55,000.

So maybe at this point you figure you will stick a bat or ball in the little tyke's hands the moment he or she can hold it in hopes they are on the road toward winning an athletic scholarship. But let's face it: That's a remote possibility. Should you despair? 

Remember, you don't need the entire sum saved for college the day junior moves into a dormitory room. And during the next 17 years, your salary probably will rise along with college costs, so the numbers won't look as shocking as they do today. In addition, low- and middle-income families don't have to pay the full sticker price if they are smart about college choices.

But if you want to make paying for college as painless as possible, you are going to have to start planning now. For the next 17 years, you will have to keep your eye on the calendar. Before children are old enough to get braces, some savvy parents start helping them build the type of resumes that will win scholarships.

Still, don't count on scholarships to do all the heavy lifting. No matter how polished your child turns out to be in high school, the chances are you will have to come up with a good sum of money yourself. So start now by saving as much as you can. Anything is better than nothing. If you start saving $100 a month for college and invest it in a balanced mutual fund that's roughly divided half and half in stocks and bonds, you should have about $40,000 by the time you pack up the car with junior's belongings and head to college.

But also make sure you have your priorities right. Too many parents — especially those laden with their own college loans — want to spare their children college debt. So they plop money into a college savings account for their children, while neglecting to save for their own retirement. This is upside-down planning.

I've heard from many parents who can't retire because they put their child's education ahead of their own savings, and their child ends up finished with college, enjoying a Wall Street or a law firm salary, and is debt-free.

The rule of thumb for saving enough money for retirement is: Start saving 10 percent of pay in a 401(k), IRA or both, beginning in your 20s. If you wait until your 30s, it's 12 to 15 percent. If you happen to have an employer that offers the typical 3 percent matching money for a 401(k), you can stash away 7 percent of your own pay and — with the free money from your employer — you will hit the 10 percent mark.

For college savings, you can make investing easy and the most profitable if you keep Uncle Sam away from taxing your savings. Plop either the $2,000 limit a year into a Coverdell college savings account, or if you can manage to save more, skip the Coverdell and use a 529 college savings plan offered by a state government. Anything you save in these accounts will be tax-free for you and your child if it goes to pay for college. Tell grandparents and other relatives about the child's 529 plan, so they can send birthday and other gifts into the college fund.

Elementary school

Maybe you've been saving diligently since you helped the little tyke blow out the candle on that first birthday cake. If you were making life easy on yourself, you evaluated 529 plans, chose one with low fees and solid performance, and you've been letting the investment experts at the plan invest your money in the manner that typically is appropriate for your child's age.

Are you satisfied with the 529 plan you chose, and the investments you've chosen within the plan? You are allowed to make changes once a year — selecting a plan in another state if you want, or different investments in the plan. Remember, you don't have to stick with the plan in your state, although many states give you an extra tax break if you do. And you can save money if you go to a state 529 plan directly rather than using a financial adviser. According to Morningstar, the average cost if you do this on your own is about 0.60 percent, but with an adviser it's 1.5 percent — a much higher amount that will detract from the amount you amass.

Say your child received $2,000 from grandma at birth. In the cheap 0.60 fund, the savings would become about $6,680 by college if the investments earned 8 percent. The same investments in the 1.50 fund would be $5,720. Try this calculator: tinyurl.com/seccalc.

To identify funds Morningstar thinks are best, go to tinyurl.com/bestfunds. Also check out savingforcollege.com.

As you evaluate the investments, keep in mind what "age-based" means. With that approach, the plan typically invests for you based on the child's age. Up to 4 years old, the money was probably invested about 80 percent in stocks and 20 percent in bonds. Between 5 and 10, it was probably 65 percent in stocks and 35 percent in bonds. The idea is to increase the money as much as possible when the child is young by using a significant amount of stocks. Then the closer the child gets to college, the more conservative the investing becomes so there's less chance of a loss when the first tuition bill rolls around.

You can lose money in 529 plan investments when the stock market goes down, but if investments turn more conservative along the way, you generally have time to recover by college. Many plans offer conservative investments if you can't stomach stocks. But remember the trade-offs. If you select a money market fund or CDs paying 2 percent interest, your $100 in savings a month would total less than $25,000 by the time a newborn makes it to college.

If you have been getting raises every year, consider increasing your contributions to the 529 plan — maybe setting up your account to move money automatically each payday. Also make sure you tell grandma and grandpa not to open any UGMA or UTMA account in the child's name. If your child is going to qualify for financial aid when he or she goes to college, a UGMA or UTMA will poison his chances.

Want to know if you are likely to get financial aid? For a ballpark idea, try the "estimated family contribution" calculator at the college you think your child might attend or: tinyurl.com/finaidest.

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Dart on releasing murder convict: 'We let people down, no mistake'

A convicted murderer from Indiana is on the loose because of some bad paperwork in Cook County. (WGN - Chicago)

Convicted murderer Steven Robbins was arrested late Friday in Kankakee, two days after he was mistakenly released from the Cook County Jail after being brought to Chicago to dispose of an old case against him, according to the Cook County sheriff's office.

Robbins, 44, who was serving a 60-year sentence for murder in Indiana, was apprehended "without incident" at about 10:55 p.m. in the 400 block of Frasier Avenue in Kankakee, according to Frank Bilecki, a spokesman for Cook County Sheriff Tom Dart. 

 Bilecki said Dart was on the scene and helped assist in the arrest. 

 Authorities tracked Robbins through interviews with family and friends who helped provide his location, according to the sheriff's office. 

Earlier, Cook County Sheriff Tom Dart took responsibility for mistakenly letting Robbins walk out of County Jail after a local charge against him was dismissed.

“We let people down, no mistake about it,” Dart said in an interview at sheriff’s offices in Maywood. “Our office did not operate the way it should have, clearly.”

The FBI, the U.S. Marshals Service and Cook County Crimestoppers raised $12,000 as a reward for information leading to Robbins’ capture, he said.

Dart said his office is still looking at where and how the system broke down to allow Robbins’ mistaken release from the jail,  but he said that officials at the  jail had no paperwork showing he was serving time in an Indiana prison for murder.

Like other indigent people, Robbins was outfitted with clothing from Goodwill – a long-sleeve brown shirt and brown pants – before being released out the front entrance, Dart said. He also likely was given bus fare.

Dart said the sheriff’s office uses an archaic system – entirely paper-driven – in handling the movement of an average of about 1,500 inmates every day. Some are entering the jail after their arrest and others are being bused to courthouses around the county for court appearances.

The sheriff said the warrant for Robbins’ arrest should have been quashed by prosecutors when armed violence charges were dismissed against him in 2007. In addition, he said prosecutors signed off on the sheriff’s office traveling to Indiana to pick up Robbins at the prison in Michigan City and bring him back on the outstanding warrant.

“We were able to get an extradition warrant on a case that didn’t exist,” Dart said. “That’s the first problem.”

Earlier, documents reviewed by the Tribune showed that paperwork filled out by Cook County sheriff’s officers this week made it clear that Robbins was serving a 60-year sentence for murder in Indiana and was to be returned to authorities there after being brought to Chicago to dispose of an old case against him.

“Please be advised that this subject is in our custody under the temporary custody provision of the interstate agreement on detainers,” a sheriff’s order accompanying Robbins’ paperwork read. The order noted Robbins’ murder conviction and 60-year sentence and then stated he “must be returned to the custody of Indiana DOC.”

In addition, Judge Rickey Jones, assigned to the Leighton Criminal Court Building, ordered the Illinois case dismissed on Wednesday and wrote on paperwork that Robbins was to be released for “this case only,” the records show.
 
Yet Robbins was allowed to walk free out of the Cook County Jail Wednesday evening after his court appearance. Authorities today were reviewing the paperwork in Robbins’ file to see how the mistake was made and who was responsible, sources told the Tribune.

Also under investigation was why Robbins – whose 1992 charges of armed violence and drug possession had been dismissed by prosecutors nearly six years ago – was even brought to Chicago in the first place.

Robbins spent the night in the Cook County Jail on Tuesday to attend a court date Wednesday on a warrant issued when he skipped bail in his 1992 case, Frank Bilecki, a spokesman for the Cook County sheriff’s office, said on Thursday.

Cook County authorities picked up Robbins on Tuesday at a prison in Michigan City, Ind., explaining he needed to answer to pending charges in Chicago, said Doug Garrison, a spokesman for the Indiana Department of Corrections. The requisite paperwork spelled out the terms of his release and return, Garrison said.

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BlackBerry 10 installed base to reach 20 million in 2013, Windows Phone to reach 45 million

Despite showing clear promise and being a tremendous upgrade compared to earlier BlackBerry software, BlackBerry 10 didn’t receive the warmest welcome when it was unveiled earlier this week. At least one leading market research firm thinks BlackBerry (RIMM) has done enough to gain some good traction in 2013, however. ABI Research released new estimates this week projecting that the BlackBerry 10 installed base will reach 20 million by the end of 2013. The firm also says Microsoft’s (MSFT) Windows Phone platform, which struggled to garner interest in its early days, will see its installed base climb to 45 million by the end of the year.

[More from BGR: BlackBerry doesn’t need to catch up with Android and iOS overnight, it needs to live to fight another day]

“2013 should be seen as relative success for both Microsoft and BlackBerry,” ABI analyst Aapo Markkanen said. ”For the end of the year, we expect there to be 45 million Windows Phone handsets in use, with BlackBerry 10 holding an installed base of close to 20 million. Microsoft will also have 5.5 million Windows-powered tablets to show for it.”

[More from BGR: GS: Ignore the chatter, BlackBerry rebound is coming]

According to ABI, these figures will be “enough to keep developers interested” as the two companies battle for the No.3 spot in the smartphone war.

“The greatest fear for both Microsoft and BlackBerry is that the initial sales of their smartphones will disappoint and thereby kill off the developer interest, which then would effectively close the window of opportunity on further sales success. Our view is that the installed bases of this scale would be large enough to keep these two in the game,” Markkanen noted. ”It will definitely also help that both firms have actively kept the developers’ interest in mind while designing and rolling out their platforms.”

This article was originally published on BGR.com

Gadgets News Headlines – Yahoo! News

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Schwarzenegger: Simple Austrian upbringing made me green

VIENNA (Reuters) – Arnold Schwarzenegger credited his simple upbringing amid the lakes and hills of Austria for a recent conversion to fully fledged green activism, the latest stage in his varied career.

The former body-builder, star of the “Terminator” action films and governor of California grew up in Thal, a small village in the Austrian province of Styria, and emigrated to the United States at the age of 21.

“Growing up in my house, we knew about sustainability before it was hip. We called it ‘necessity’,” Schwarzenegger told an environmental conference he hosted in Vienna this week.

“We didn’t have video games, televisions or iPhones. We had the rolling hills, the castles, the ruins, and the beautiful lakes,” he said. “Even after I made it big and became governor of California, I held on to this love of nature.”

The “governator” – who left office and split with his wife of 25 years, Maria Shriver in 2011, has recently returned to making action movies – expressed surprise at the turn his life had taken, after he had thought all his ambitions fulfilled.

“When I was a little boy in Austria, all I could think about was moving to America, to become the greatest bodybuilder champion in the world and make millions of dollars and be an action hero,” said Schwarzenegger.

“My dream became reality. Who knew my greatest achievement would be in the real world fighting for a green energy future? Green energy wasn’t even in my vocabulary.”

(Reporting by Derek Brooks; Writing by Georgina Prodhan, editing by Paul Casciato)

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Chicago beer firm Crown Imports is caught in antitrust fight

An antitrust brouhaha in Washington has thrown the future of Crown Imports, a Chicago-based beer importer, into question.

The company, which ranks third in U.S. beer sales volume, is a joint venture between New York-based Constellation Brands Inc. and Mexico's Grupo Modelo, which makes Corona Extra, the leading imported beer in the U.S., and other brands. Crown sells Modelo brands as well as China's Tsingtao.

As part of its proposed sale to Anheuser-Busch InBev, Grupo Modelo agreed to sell its 50 percent stake in Crown to Constellation Brands for $1.85 billion. The separate transaction was meant to ease possible antitrust concerns that the merger would eliminate Crown Imports as a competitor.

But on Thursday the U.S. Department of Justice filed an antitrust suit against AB InBev to block its acquisition of Grupo Modelo. Antitrust officials said the merger would further increase the concentration of the U.S. beer market, leading to higher prices for American consumers.

The lawsuit said the sale of Modelo's interest in Crown Imports to its partner would only create "a facade of competition" between AB InBev and the importer.

"In reality, Defendants' proposed 'remedy' eliminates from the market Modelo — a particularly aggressive competitor — and replaces it with an entity wholly dependent on ABI," the Justice Department said in the lawsuit.

The suits cites as evidence part of an internal memo that Crown's chief executive, Bill Hackett, wrote to employees after the transactions were announced in June. According to the suit, Hackett wrote, "Our #1 competitor will now be our supplier ... it is not currently or will not, going forward, be 'business as usual.'"

Under the terms of the proposed merger with Modelo, AB InBev also had the option to terminate its agreement with Crown Imports after 10 years, giving it full control of Corona distribution.

Constellation Brands on Friday attacked the Justice Department, saying in a statement that the suit "demonstrates its incomplete understanding" of the proposed merger. Constellation and AB InBev have indicated that they plan to challenge the suit.

In a detailed defense, Constellation said its full control of Crown would improve competition, not harm it. According to the lawsuit, Modelo controls about 7 percent of U.S. beer sales, far behind AB InBev's market-leading 39 percent.

Constellation attempted to ease concerns that AB InBev's merger with Modelo would lead to higher prices. Hackett said in a statement: "Our Crown team independently develops, implements and refines pricing, promotional and sales strategies for each of our brands in the U.S."

The proposed beer merger had reduced uncertainty hanging over Crown Imports because the Modelo-Constellation joint venture was set to expire at the end of 2016. The Justice Department action creates a new level of uncertainty, said Benj Steinman, president of Beer Marketer's Insights, a beer industry trade publication.

"Crown's fate is hanging in the balance," Steinman said.

asachdev@tribune.com

Twitter@ameetsachdev

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Convicted murderer mistakenly released from Cook County Jail

An Indiana man convicted of murder has been on the loose since Wednesday night after Cook County Jail officials mistakenly released him, authorities said.

The sheriff's office confirmed that Steven Robbins, 44, was released after appearing in Cook County court on armed violence and drug charges, and the charges were dismissed.

But the office didn't alert the public that Robbins, who was convicted of a 2002 fatal shooting a Kentucky man, was on the loose until Thursday evening.

Robbins spent the night in the Cook County Jail on Tuesday to attend a court date Wednesday on a warrant for a 1992 criminal case, in which he was charged with armed violence — committing a felony while using a gun, said Frank Bilecki, a spokesman for Cook County Sheriff Tom Dart.

After attending the court hearing, Robbins was released at 7 p.m. Wednesday because there was no indication in his jail paperwork that he was ordered to remain in custody, Bilecki said. Robbins left through the jail's main entrance.

On Thursday, the Cook County fugitive warrant unit called the jail to make arrangements to send Robbins back to an Indiana prison. Jail staff realized that Robbins was gone.

The sheriff's office and other law enforcement agencies, including the FBI and U.S. Marshals Service, were notified.

Authorities didn't want Robbins to immediately know that they were on to him, which is why the public wasn't told right away, Bilecki said.

"We were trying to hit all the spots where we thought he might be before he became aware that we were looking for him," he said.

A warrant for Robbins has been issued in Illinois and Indiana.

In a telephone interview, Robbins' ex-wife, Nicole Robbins, who divorced him in 2008, said she hadn't spoken with or heard from him in a year and a half.

"He was mistakenly released? I haven't heard from him," she said. "I don't know where he is."

Steven Robbins was serving time in Indiana State Prison when he was brought to Cook County to appear on the warrant.

In 2002, Robbins was arrested at a Day's Inn in Merrillville, Ind., according to an archived story in the Merrillville Post-Tribune. He was convicted of shooting Richard Melton, 24, with whom he'd gotten into a fight at a party. Robbins shot Melton on Mother's Day, authorities said.

He was sentenced in 2004 to 60 years in prison for murder and carrying a handgun without a license, according to Indiana Department of Correction documents. He was eligible for parole in 2029. Robbins has relatives in Gary and Bloomington, according to the archived story.

Robbins was described as black, 5 feet 5 inches tall and 190 pounds, with a tattoo on the right side of his neck that reads "Nicole." Anyone with information on Robbins' whereabouts is asked to call 708-865-4915.

The Cook County charges had actually been dropped in 2007, but Robbins was still required to appear in court in Illinois to answer for the warrant on those charges, court records show.

Tribune reporters David Heinzmann and Jeremy Gorner contributed.

ehirst@tribune.com

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Sony ignites talk of PS4 unveil with Playstation meeting

TOKYO (Reuters) – Sony Corp will this month host its first major Playstation meeting in two years, sparking a flare-up in online speculation the Japanese consumer electronics giant is preparing to unveil the successor to its 70 million-selling PS3 games console.

Sony declined to say whether it would release a new product at the meeting in New York on February 20. “We will be talking about the Playstation business,” spokesman Masaki Tsukakoshi said on Friday. A Google search for “Sony Feb 20 Playstation” returned more than 7 million hits.

The last time Sony held a Playstation event, in January 2011, it presented a protoype of its handheld Vita console. Before that, it convened a gathering in 2005 two months after it first demonstrated the PS3 concept. A meeting in 1999 revealed designs for the PS2.

It has been more than six years since Sony launched the PS3 home console, a longer gap than between it and its PS2 predecessor, adding to the anticipation that it will soon disclose its next gaming concept.

Since Sony’s last home console launch, the games market has been transformed by the boom in smartphones and tablet computers that have wooed players with free or cheap games.

Sony and other console makers Nintendo Co Ltd and Microsoft Corp now have to contend with competition from hand-held devices made by Apple Inc, Samsung Electronics and others.

Analysts expect that tablets and other mobile devices will match the power and graphics of today’s games consoles within a few years.

Struggling under competitive pressure, Nintendo on Wednesday cut its sales target for the Wii U, successor to its 100 million-selling Wii, to 4 million machines by the end of March from its launch in November, compared with an earlier forecast for 5.5 million.

(Reporting by Tim Kelly; Editing by Daniel Magnowski)

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Whitney Houston anniversary to be marked with TV Grammy special

LOS ANGELES (Reuters) – Grammy organizers plan to mark the first anniversary of the sudden death of Whitney Houston with a behind-the-scenes TV show on how they scrambled to honor the singer just 24 hours after she died.

The Recording Academy said on Thursday that the hour-long special entitled “The Grammys Will Go On: A Death in the Family” will air on February 9, the day before the 2013 Grammy Awards ceremony in Los Angeles.

Houston, who sold hundreds of millions of records and scored the mega hits “I Will Always Love You” and “I Wanna Dance with Somebody,” drowned in a bathtub at a Beverly Hills hotel room on February 11 2012 – the eve of last year’s Grammy Awards show.

Houston’s unexpected death at age 48 cast a shadow over the event, which quickly changed its program to pay homage to the soaring voice that had dominated the Grammys in decades past.

Singer and actress Jennifer Hudson performed a medley of Houston’s hits at last year’s Grammys, and rapper and host LL Cool J opened the show with a prayer.

The TV special on broadcaster CBS features rehearsals and interviews with artists – including Hudson, Bruce Springsteen and Taylor Swift – and the show’s producers in the hours before and after Houston’s death.

The Recording Academy produces the annual Grammy awards.

(Reporting by Eric Kelsey, editing by Jill Serjeant and David Brunnstrom)

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Insurance Industry Report Faults High Fees for Out-of-Network Care

Michael Nagle for The New York Times

Angel Gonzalez, 36, faced huge bills after emergency gallbladder surgery, despite having good insurance coverage. “I was on the hook for more than I made in a year.”

Just over a year ago, Angel Gonzalez, 36, awoke with searing chest pain at 2 a.m. A friend drove him to the closest emergency room.

Though he was living on $18,000 a year as a graduate student, Mr. Gonzalez had good insurance and the hospital, St. Charles in Port Jefferson, N.Y., was in his network. But the surgeon who came in to remove Mr. Gonzalez’s gallbladder that Sunday night was not.

He billed Mr. Gonzalez $30,000, and an assistant billed an additional $30,000. Mr. Gonzalez’s policy covered out-of-network providers, but at a rate it considered appropriate: $2,000. “I was on the hook for more than I made in a year,” Mr. Gonzalez said.

A health insurance industry report to be released on Friday highlights the exorbitant fees charged by some doctors to out-of-network patients like Mr. Gonzalez. The report, by America’s Health Insurance Plans, or AHIP, contrasts some of the highest bills charged by non-network providers in 30 states with Medicare rates for the same services. Some of the charges, the insurers assert, are 30, 40 or nearly 100 times greater than Medicare rates.

Insurers hope to spotlight a vexing problem that they say the Affordable Care Act does little to address. “When you’re out of network, it’s a blank check,” said Karen Ignagni, president and chief executive of AHIP. “The consumer is vulnerable to ‘anything goes.’ ”

“Unless we deal with cost, we won’t have affordability,” she added. “And unless we have affordability, we won’t have people participating” under the Affordable Care Act.

Among the fees on the report’s list are a $6,205 outpatient office visit to a doctor in Massachusetts for which Medicare would have paid $152; a $12,000 bill for examining a tissue specimen in New York for which Medicare would have paid $128; and a $48,983 surgeon’s fee for a total hip replacement in New Jersey that Medicare would have reimbursed at $1,543. Many of the highest billers were in New York, Texas, Florida and New Jersey.

Elisabeth R. Benjamin, co-founder of the Health Care for All New York coalition, who is often at odds with the insurance industry, said that “is one area we totally agree on.” She continued, “Out-of-network billing is just out of control.”

Even when out-of-network fees are compared with average commercial insurance reimbursements, which are usually greater than Medicare, she said, “It’s pretty outrageous.”

Doctors say the report is skewed because it focuses on a few dozen cases of overcharging that are not representative of their billing. In response to the insurers’ report, the American Medical Association noted on Thursday that a recent analysis found that doctors’ services account for just 16 percent of health care costs.

“There are outliers in every profession, in every business,” said Dr. Andrew Y. Kleinman, a plastic surgeon who is vice president of the Medical Society of the State of New York.

Dr. Kleinman also noted that insurers had effectively shifted the costs of out-of-network care onto patients by changing reimbursement formulas. Instead of the rates commercial insurers usually pay doctors, insurers increasingly are basing their out-of-network payments on Medicare rates, usually far lower.

A growing number of high-end, flexible health plans offer policies that cover outside providers at, for example, 140 percent of Medicare. “They’re selling you an insurance product you can’t use,” Dr. Kleinman said. “You’re buying an insurance policy where the out-of-network benefit is worthless.”

The industry’s own report suggests that using Medicare rates as a benchmark will lead to patients’ picking up much more of the cost for out-of-network care, whether they carefully select a specialist or, as in the case of Mr. Gonzalez and many others, have no choice in the matter.

Had Mr. Gonzalez been 65 or older, Medicare would have paid only $958 for the surgery. The average commercial price is $12,292, according to FAIR Health, an independent nonprofit group that tracks information on health care costs.

But Mr. Gonzalez’s health plan, United Healthcare, determined the fee should be $1,273, of which the company paid $838. Mr. Gonzalez filed appeals, which were rejected. He then contacted Community Health Advocates at the Community Service Society of New York for help, and the group’s caseworkers negotiated with the surgeon on his behalf.

After months of wrangling, the surgeon agreed to accept a significantly reduced payment: $340.

Consumer advocates and health insurance executives are calling for greater transparency in health care pricing, including upfront disclosure of prices of medical procedures and services.

“The health care industry can give you an estimate, just like any other industry,” said Carrie H. Colla, an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice, noting that the Dartmouth-Hitchcock Medical Center has a patient price estimator online.  

“It’s just not current practice right now,” Dr. Colla said. “Sometimes a doctor won’t even know. The patient really has to push for it.”

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