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Jul
16

Harvard Medical School: Out-of-Network Care

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....
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Jun
02

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 ...
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Jun
01

Health Affairs: Out-Of-Network Spending Mostly Declined In Privately Insured Populations With A Few Notable Exceptions From 2008 To 2016

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...
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May
28

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 out-of-network billing,...
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Nov
21

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 specialty are paid for delivering sim...
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Nov
05

Comparing Average Rates for Select Anesthesiology, Emergency Medicine, and Radiology Services by Local Areas

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 ...
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Mar
28

Surprise out-of-network medical bills during in-network hospital admissions varied by state and medical specialty, 2016

 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...
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Jun
25

Medical Care Research and Review: Prices for Physicians’ Services in Medicare Advantage and Commercial Plans

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...
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