Sarah A Friedman1, Haiyong Xu1, Francisca Azocar1, Susan L Ettner1. 1. School of Public Health, University of Nevada, Reno (Friedman); Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine (Xu, Ettner), and Department of Health Policy and Management, Fielding School of Public Health (Ettner), University of California, Los Angeles, Los Angeles; Optum, San Francisco (Azocar).
Abstract
OBJECTIVE: The study estimated balance billing for out-of-network behavioral health claims and described subscriber characteristics associated with higher billing. METHODS: Claims data (2011-2014) from a national managed behavioral health organization's employer-sponsored insurance (N=196,034 family-years with out-of-network behavioral health claims) were used to calculate inflation-adjusted annual balance billing-the submitted amount (charged by provider) minus the allowed amount (insurer agreed to pay plus patient cost-sharing) and any discounts offered by the provider. Among family-years with complete sociodemographic data (N=68,659), regressions modeled balance billing as a function of plan and provider supply, subscriber and family-year, and employer characteristics. A two-part model accounted for family-years without balance billing. RESULTS: Among the 50% of family-years with balance billing, mean±SD balance billing was $861±$3,500 (median, $175; 90th percentile, $1,684). Adjusted analysis found balance billing was higher ($523 higher, 95% confidence interval [CI]=$340, $705) for carve-out versus carve-in plans and for health maintenance organization (HMO) enrollees versus non-HMO enrollees ($156, 95% CI=$75, $237); for subscribers with a bachelor's degree, compared with an associate's degree or with a high school diploma or lower (between $172 [95% CI=$228, $116] and $224 [95% CI=$284, $163] higher, respectively); and for subscribers ages 45-54, compared with those ages 35-44 and 18-24 (between $57 [95% CI=$103, $10] and $290 [95% CI=$398, $183] higher, respectively). Balance billing was lower in states with more in-network providers per capita (-$8, 95% CI=-$10, -$5). CONCLUSIONS: Balance billing for out-of-network behavioral health claims may be burdensome. Expanded behavioral health networks may improve access.
OBJECTIVE: The study estimated balance billing for out-of-network behavioral health claims and described subscriber characteristics associated with higher billing. METHODS: Claims data (2011-2014) from a national managed behavioral health organization's employer-sponsored insurance (N=196,034 family-years with out-of-network behavioral health claims) were used to calculate inflation-adjusted annual balance billing-the submitted amount (charged by provider) minus the allowed amount (insurer agreed to pay plus patient cost-sharing) and any discounts offered by the provider. Among family-years with complete sociodemographic data (N=68,659), regressions modeled balance billing as a function of plan and provider supply, subscriber and family-year, and employer characteristics. A two-part model accounted for family-years without balance billing. RESULTS: Among the 50% of family-years with balance billing, mean±SD balance billing was $861±$3,500 (median, $175; 90th percentile, $1,684). Adjusted analysis found balance billing was higher ($523 higher, 95% confidence interval [CI]=$340, $705) for carve-out versus carve-in plans and for health maintenance organization (HMO) enrollees versus non-HMO enrollees ($156, 95% CI=$75, $237); for subscribers with a bachelor's degree, compared with an associate's degree or with a high school diploma or lower (between $172 [95% CI=$228, $116] and $224 [95% CI=$284, $163] higher, respectively); and for subscribers ages 45-54, compared with those ages 35-44 and 18-24 (between $57 [95% CI=$103, $10] and $290 [95% CI=$398, $183] higher, respectively). Balance billing was lower in states with more in-network providers per capita (-$8, 95% CI=-$10, -$5). CONCLUSIONS: Balance billing for out-of-network behavioral health claims may be burdensome. Expanded behavioral health networks may improve access.
Authors: Amber Gayle Thalmayer; Sarah A Friedman; Francisca Azocar; Jessica M Harwood; Susan L Ettner Journal: Psychiatr Serv Date: 2016-12-15 Impact factor: 3.084
Authors: Sarah A Friedman; Amber G Thalmayer; Francisca Azocar; Haiyong Xu; Jessica M Harwood; Michael K Ong; Laura Lambert Johnson; Susan L Ettner Journal: Health Serv Res Date: 2016-12-12 Impact factor: 3.402
Authors: Karan R Chhabra; Kyle H Sheetz; Ushapoorna Nuliyalu; Mihir S Dekhne; Andrew M Ryan; Justin B Dimick Journal: JAMA Date: 2020-02-11 Impact factor: 56.272