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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