In a new study that sheds light on 'surprise billing,' researchers found that insurers paid out-of-network reimbursements in emergency medicine that were about double the median in-network rates. MedTwitter
on January 1, 2022. The law attempts to address the problem of"surprise billing," which can leave patients with exorbitant and unexpected medical bills when out-of-network medical professionals provide care.
For the study, Duffy and colleagues analyzed 2019 emergency medicine claims data from Aetna, Humana, and some Blue Health Intelligence plans. They focused on the median QPA,"which was calculated as the median allowed amount of all observed claims within strata defined by geographic region, CPT code, and funding market."
Self-insured plans were more likely to pay higher out-of-network payments than fully insured plans ."High out-of-network allowed amounts protect patients from surprise medical bills, since the magnitude of a surprise bill is the balance between the charge and allowed amount," Duffy said."Large self-insured employers have had an interest in protecting their employees from surprise bills, and they were willing to make high out-of-network payments to do so.
"Perhaps they were likelier to cover out-of-network care," he said."Or perhaps they are more generous in the share of fees they covered. I would have used the term 'self-insured,' meaning the employer bears the risk of higher claims, not the insurer. I don't think this is a great practical distinction for patients, caregivers, or US health costs.
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