Out-of-Network
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Harvard Medical School: Out-of-Network Care
Tags: Out-of-Network
Read more: Harvard Medical School: Out-of-Network CareHCCI’s research on out-of-network spending was cited in the Harvard Medical School publication. From the article: “In a study published in the June issue of Health Affairs, the researchers found that while the share of total health care spending that was out of network declined slightly from 2008 to 2016, there was a rapid increase…
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Health Affairs Blog: Out-of-Network Spending: Why Growing Attention Is Focused On A Small Share Of Medical Spending
Tags: Out-of-NetworkRead more: Health Affairs Blog: Out-of-Network Spending: Why Growing Attention Is Focused On A Small Share Of Medical SpendingIn HCCI’s publication in Health Affairs Blog, we examine the cost and utilization of out-of-network care in commercial claims. From the article: “People receiving surprise bills, sometimes totaling tens of thousands of dollars, have been frequently chronicled by high-profile media stories and in academic research over the past several years. Previous research from the Health Care Cost…
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Health Affairs: Out-Of-Network Spending Mostly Declined In Privately Insured Populations With A Few Notable Exceptions From 2008 To 2016
Tags: Out-of-NetworkRead more: Health Affairs: Out-Of-Network Spending Mostly Declined In Privately Insured Populations With A Few Notable Exceptions From 2008 To 2016In HCCI’s publication in Health Affairs, we examined out-of-network spending in the privately insured population. Abstract: “While out-of-network or potential “surprise” billing has garnered increasing attention, particularly in emergency department and inpatient settings, few national studies have examined out-of-network care overall or in other settings. We examined out-of-network spending and use among two large nationwide…
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How often do providers bill out of network?
Read more: How often do providers bill out of network?In recent analysis, we document extensive variation across states and metropolitan areas in the frequency of out-of-network visits among individuals with health insurance provided by an employer. These differences raise the question of whether individual providers bill out of network at dissimilar rates. To explore whether a small group of providers are responsible for most…
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Health Affairs: Prevalence And Characteristics Of Surprise Out-Of-Network Bills From Professionals In Ambulatory Surgery Centers
Read more: Health Affairs: Prevalence And Characteristics Of Surprise Out-Of-Network Bills From Professionals In Ambulatory Surgery CentersAbstract: Patients treated at in-network facilities can involuntarily receive services from out-of-network providers, which may result in “surprise bills.” While several studies report the surprise billing prevalence in emergency department and inpatient settings, none document the prevalence in ambulatory surgery centers (ASCs). The extent to which health plans pay a portion or all of out-of-network…
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The Wall Street Journal: White House Applauds Bipartisan Congressional Deal to Curb Surprise Medical Bills
Read more: The Wall Street Journal: White House Applauds Bipartisan Congressional Deal to Curb Surprise Medical BillsHCCI’s work on out-of-network billing was cited in a Wall Street Journal article on a congressional deal to curb surprise billing. From the article: “In surprise bills, patients can be charged nondiscounted rates from out-of-network providers. An insurance plan may not cover that bill, or may pay part of the cost at a lower rate than…
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Health Affairs: Surprise Bills, Benchmarks, And The Problem Of Indexation
Read more: Health Affairs: Surprise Bills, Benchmarks, And The Problem Of IndexationHCCI data was cited in a Health Affairs blog article on surprise billing. From the Article: “Over the past year, the congressional debate over surprise billing has converged on two policy options to resolve out-of-network payments—1) a simple benchmark, in which a health plan pays out-of-network providers the median rate agreed with local in-network providers…
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How common is out-of-network billing?
Tags: Commercially Insured, Emergency Room, Geographic Variation, Mental Health and Substance Use, Out-of-Network, Surprise BillingRead more: How common is out-of-network billing?Congress is considering legislation to address “surprise bills”, which occur when a person visits an in-network facility, but receives services from a provider that is outside of their insurer’s network. Bills in both the House and Senate include provisions to determine a benchmark rate for out-of-network payments based on what in-network providers of the same…
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Comparing Average Rates for Select Anesthesiology, Emergency Medicine, and Radiology Services by Local Areas
Tags: Commercially Insured, Emergency Room, Geographic Variation, Medicare, Out-of-Network, Physician Spending
Read more: Comparing Average Rates for Select Anesthesiology, Emergency Medicine, and Radiology Services by Local AreasWhen a person unknowingly receives health care services from a provider that is outside of their insurer’s network, it gives rise to the potential for a “surprise bill”. Congress continues to consider legislation aimed at reducing the financial burden of “surprise bills” for patients. The approach approved by committees in both the House and Senate…
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Health Affairs: Surprise Billing: Choose Patients Over Profit
Read more: Health Affairs: Surprise Billing: Choose Patients Over ProfitHCCI’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…