The Out-of-Network Benefit: Problems and Policy Solutions
Open Access
- 1 November 2012
- journal article
- research article
- Published by SAGE Publications in INQUIRY: The Journal of Health Care Organization, Provision, and Financing
- Vol. 49 (4), 352-361
- https://doi.org/10.5034/inquiryjrnl_49.04.02
Abstract
Health insurance plans that include coverage for out-of-network providers are common and have the potential to reduce health care costs and even improve quality. Yet, consumers may be exposed to significant unexpected and unreasonable out-of-pocket costs due to lack of accurate information on network participation, nontransparent out-of-pocket costs, inadequate provider networks, involuntary use of out-of-network emergency care, and use of out-of-network providers at in-network hospitals. Although the Affordable Care Act and some states provide some consumer protections, these may not be adequate.Keywords
This publication has 8 references indexed in Scilit:
- Does Price Transparency Legislation Allow the Uninsured to Shop for Care?Journal of General Internal Medicine, 2009
- Balance BillingAnnals of Emergency Medicine, 2009
- California court bans emergency physician balance billing: Emergency physicians decry major blow to beleaguered emergency care safety net.Annals of Emergency Medicine, 2009
- Assessing New Patient Access to Mental Health Providers in HMO NetworksPsychiatric Services, 2008
- Financial Protection Afforded by Employer-Sponsored Health InsuranceMedical Care Research and Review, 2007
- Parity And The Use Of Out-Of-Network Mental Health Benefits In The FEHB ProgramHealth Affairs, 2007
- Provider turnover in public sector managed mental health careThe Journal of Behavioral Health Services & Research, 2004
- Health LiteracyPublished by The National Academies Press ,2004