In the context of concerns about the appropriateness and costs to insurers and patients of laboratory testing, this study uses data from the IBM MarketScan Commercial Claims and Encounters Database to examine out-of-network laboratory test spending, utilization, and prices in the US in 2008-2016.
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| http://dx.doi.org/10.1001/jama.2021.0720 | DOI Listing |
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Out-of-Network Laboratory Test Spending, Utilization, and Prices in the US.
JAMA
April 2021
Yale School of Public Health, New Haven, Connecticut.
In the context of concerns about the appropriateness and costs to insurers and patients of laboratory testing, this study uses data from the IBM MarketScan Commercial Claims and Encounters Database to examine out-of-network laboratory test spending, utilization, and prices in the US in 2008-2016.
View Article and Find Full Text PDFFrequency and Costs of Out-of-Network Bills for Outpatient Laboratory Services Among Privately Insured Patients.
JAMA Intern Med
June 2021
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Importance: Patients may be unaware of which laboratory is processing their clinical tests, limiting their ability to choose an in-network laboratory. Out-of-network laboratory services could increase patients' out-of-pocket costs and their reluctance to obtain necessary tests.
Objective: To evaluate the frequency and cost of out-of-network bills for outpatient laboratory services compared with other services.
Out-Of-Network Spending Mostly Declined In Privately Insured Populations With A Few Notable Exceptions From 2008 To 2016.
Health Aff (Millwood)
June 2020
Jacob Wallace is an assistant professor of Public Health in the Department of Health Policy and Management, Yale School of Public Health, in New Haven, Connecticut.
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 spending and use among two large nationwide populations with employer-sponsored insurance. In a primary sample of 27,883,040 people in data for 2008-16 from the Truven MarketScan Commercial Claims and Encounters Database, we found that the unadjusted share of total spending that occurred out of network decreased from 7.
View Article and Find Full Text PDFPrevalence And Characteristics Of Surprise Out-Of-Network Bills From Professionals In Ambulatory Surgery Centers.
Health Aff (Millwood)
May 2020
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-of-network providers' bills in these situations is also unexplored.
View Article and Find Full Text PDFSuccessful Implementation of Low-Cost Tele-Critical Care Solution by the U.S. Navy: Initial Experience and Recommendations.
Mil Med
May 2017
U.S. Army Institute of Surgical Research, 3698 Chambers Pass, Suite B, JBSA Fort Sam, Houston, TX 78234.
Intensivist physician involvement has been shown to improve outcomes for critically ill patients. Unfortunately, the number of Intensivists nationally is unable to meet the current demand. Similar to the civilian community, the Navy critical care workforce is limited by available resources.
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