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HCCI'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 in out-of-network spending for several distinct segments of the U....

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 ...

In 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 sp...

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 out-of-network billing,...

Abstract:  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-o...

HCCI'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 the doctor charges. Ending such bills has been ...

​HCCI 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 in the same specialty, or...

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 specialty are paid for delivering sim...

When 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 is to set a benchmark for the amount that can be ...

 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 ...

HCCI's research on out-of-network billing was recently cited by a CBS Evening News report on the topic. Family hit with $3,700 bill for out-of-network anesthesiologist - CBS News When Adam and Laura Parkinson chose their hospital and obstetrician for the birth of their son, they didn't think they would get hit with a surprise bill for the epidural https://www.cbsnews.com/news/out-of-netwo...

 Out-of-network billing practices have increasingly garnered attention as individuals with commercial health insurance continue to experience "surprise billing." A surprise medical bill commonly describes a charge to a patient for care delivered by an out-of-network (OON) professional who works within an in-network facility. We used the Health Care Cost Institute's (HCCI) vast commercial...

HCCI's recent report on rising insulin prices was cited in support of congressional  inquiries into drug pricing. This included a letter from U.S. Senator Tim Kaine (D-VA) to executives at Eli Lilly, Novo Nordisk, and Sanofi requesting information on insulin pricing.  Additionally, HCCI's research on emergency care was cited in a letter from U.S. Senators Bill Cassidy (R-LA)&nb...

ABSTRACT: The prices that insurers pay physicians ultimately affect beneficiaries' health insurance premiums. Using 2014 claims data from three major insurers, we analyzed the prices insurers paid in their Medicare Advantage (MA) and commercial plans for 20 physician services, in and out of network, and compared those prices with estimated amounts that Medicare's fee-for-service (FFS) program...