All HCCI Reports
HCCI’s original reports powered by #HCCIdata

Health Affairs Blog: Out-of-Network Spending: Why Growing Attention Is Focused On A Small Share Of Medical Spending

In 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 Institute (HCCI) has shown that one in seven in-network inpatient admissions had an associated out-of-network claim in 2016. The average potential surprise bill, defined as the difference between the charges and the allowed amounts for out-of-network claims, varies substantially by type of service and was over $22,000 for inpatient surgery. In response, both houses of the United States Congress have pursued bipartisan legislation to help protect patients from such bills.

Despite the attention garnered by out-of-network billing practices, spending on out-of-network care represents a small portion of total spending, and that proportion remained stable or, if anything, decreased over time. A collaboration between researchers at HCCI, Harvard Medical School, and Yale School of Public Health, published in the new June issue of Health Affairs (Song, et al., 2020), found that out-of-network care made up an average of 6.6 percent of total allowed spending per year from 2008 to 2016 among the commercially insured."

Stay Informed

When you subscribe to the blog, we will send you an e-mail when there are new updates on the site so you wouldn't miss them.