Surprise, out-of-network bills hurt consumers, but two new studies show these bills undermine competition between health insurance plans and particularly harm plans that are trying to limit costs by offering narrower network products.
Contracted, in-network providers agree to accept discounted reimbursement rates negotiated with health plans, and health plans typically charge patients lower cost-sharing liability for contracted services.
However, 20 percent of emergency department visits and resulting admissions at in-network facilities involved an out-of-network physician, according to the studies published in Health Affairs and The New England Journal of Medicine.
There's also the problem of balance billing beyond emergency physicians.
Because states play a large role in the regulation of insurance markets and are knowledgeable of...