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Narrow Networks Can Result in "Surprise" Bills for Patients and Employers

We've all heard the stories, or even experienced it ourselves, about finding out after-the-fact that the anesthesiologist used during surgery was out-of-network and, therefore, the patient and employer owe a lot more for those services that expected. This happens even though the hospital is in-network.

This situation is becoming even more frequent due to the expanded number of narrow-networks put in place with the advent of the Marketplace (aka public health insurance exchange) and in the growing number of employers offering narrow networks as a cost-reduction strategy.

And anesthesiology isn't the only specialty where this can happen. Emergency room physicians, pathologists, radiologists, specialists, and hospitalists are just examples of other, hospital-contracted physicians, that may not be in-network.

Although many insurance companies and self-insured employers have taken steps to protect the patient from the balance billing, the higher out-of-network costs (then picked up by the insurance company or employer) still accrue and add to the increasing high cost of care and therefore premiums.

For employers: What do you do to protect yourself, as well as your employees and their families, from this type of balance billing? How do you hold your health plan or hospitals accountable for having contracted physicians in the networks they accept?

Read more.

Posted by Cristie Travis at 9:53 AM

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