Erin L. Duffy, PhD, MPH

This cross-sectional analysis of commercially insured delivering mothers suggests that greater out-of-pocket spending is incurred when pregnancy spans 2 years, causing them to face out-of-pocket limits twice.

Hospital price transparency data suggest that health insurance exchange (HIX) plans get lower negotiated rates than commercial group plans and higher negotiated rates than Medicare Advantage plans.

Mean in-network commercial allowed amounts and charges per anesthesia conversion factor are 314% and 659% of traditional Medicare rates, respectively. Medicare Advantage payments align with traditional Medicare prices.

The No Surprises Act represents a rare bipartisan moment for Congress and a long-needed safeguard for patients that will reorient relationships among payers and providers.

In addition to protecting patients from receiving unexpected bills, policies to address surprise billing could reduce health insurance premiums by 1% to 5%.

California’s experience implementing a policy to address surprise medical billing demonstrates that out-of-network payment standards can influence payer–provider bargaining leverage, affecting prices and network breadth.