A significant portion of inpatient hospital admissions billed to large employer health plans are out-of-network charges, which can leave patients subject to balance billing, according to a new Kaiser Family Foundation analysis.
The analysis, which considered inpatient admissions and outpatient services claims from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database, examined how often these claims were paired with out-of-network charges. Almost 18 percent of inpatient admissions led to an out-of-network claim when a health plan member was part of a large employer group, researchers found. Even when enrollees picked an in-network facility, 15 percent of admissions still included a charge from an out-of-network provider.
Claims for inpatient admissions and outpatient services that included use of an emergency room were both linked to a higher rate of out-of-network bills. Mental health and substance abuse treatments were also associated with a much higher chance of incurring a bill from an out-of-network provider, according to the analysis.
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