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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."

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