Infographic: Patient Out-of-Network Fees

Wednesday, October 28th, 2015
This post was written by Melanie Matthews

Patients who seek care from out-of-network providers or specialists, see, on average, potential excess charges of 300 percent compared to Medicare’s fee for the same treatment or procedure, according to a new infographic by AHIP.

The infographic compares the out-of-network charge for 10 healthcare encounters compared with the Medicare payment for that service.

Patient Out-of-Network Fees

Narrow networks—for both medical and pharmacy providers—are gradually becoming more accepted by carriers, plan sponsors and patients. Smaller provider networks allow payers to manage overall healthcare costs while still maintaining access to benefits—an important consideration as plan designs become more commoditized in the age of public and private health insurance exchanges.

Narrow Network Strategies and Trends for Health Plans and PBMs outlines the tactics health plans are using to restrict medical and pharmacy networks while still maintaining adequate access to care and positive relationships with providers. It also summarizes case studies of health plans and PBMs that have formed narrow networks and the results they’ve seen.

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