HCCI’s research on median in-network rates was recently featured in a Health Affairs blog post on surprise billing.
From the blog:
“Most importantly, Congress should establish a locally based benchmark to determine the amount an insurer would be required to pay a provider for a surprise bill. Ideally, we’d set the benchmark at some multiple (for example 125 percent) of what Medicare pays to correct for market failures, but a benchmark tied to median rates negotiated between insurers and providers in a geographic area seems like a reasonable compromise.
Under the benchmark approach, providers would receive a local, market-based payment for their services and be limited in their ability to charge patients egregious rates, while insurers would still be responsible for paying their fair share for a patient’s care. While the Health Care Cost Institute recently found that median in-network rates varied across different states for the specialties most likely to be out of network, it also found that these rates are fairly similar for rural and urban areas within states, assuaging fears that a local benchmark would have a negative impact on rural access or providers.”
https://www.healthaffairs.org/do/10.1377/hblog20190808.585050/full/