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Member Research & Reports

Member Research & Reports

Ohio State: Out-of-network Costs Soar for Non-emergency Hospitalizations, Ohio State Study Finds

The out-of-pocket financial burden for insured working Americans is substantial and growing – especially when it comes to out-of-network, non-emergency hospital care, a new study has found.

Researchers at The Ohio State University analyzed claims from more than 22 million enrollees in private insurance plans and found that out-of-pocket costs for non-emergency out-of-network hospital care nearly doubled in five years.

The study included enrollees 18 to 64 years old who were part of an employer-sponsored plan for at least one year from 2012 to 2017.

Though the prevalence of use of out-of-network care dropped during the study period, cost-sharing for that care rose rapidly from 2012 through 2016 before slowing down in 2017. About 16 percent of individuals encountered out-of-network care, at an average out-of-pocket cost of $621.

The fastest cost-sharing increases for enrollees arose from non-emergency hospitalizations. The average out-of-pocket cost for this type of care increased from $671 to $1,286. Consumer costs for out-of-network emergency hospitalizations also rose, but less dramatically – from $452 to $565.

“These out-of-network costs are concerning because many insured Americans cannot afford to pay a higher percentage of their health care bills, and in some cases they may not even be aware that their providers are out of network,” said lead author Dr. Wendy Yi Xu, a health economist and assistant professor of health services management and policy at Ohio State.

The study appears online in the American Journal of Managed Care.

In the paper, the authors call on policymakers and others to consider the burdens on working Americans and to seek solutions.

Read more.

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