August 12, 2009

The Value of Provider Networks & the Role of Out-of-Network Charges in Rising Health Care Costs: A Survey of Charges Billed by Out-of-Network Physicians

In May 2009, America's Health Insurance Plans (AHIP) asked Dyckman & Associates (Dyckman) to collect and analyze results of a survey of AHIP member plans in order to identify the highest 2008 billed charges by non-participating physicians in the 30 most populous states for certain Current Procedural Terminology codes representing various categories of physician services. Surveys were returned to Dyckman from ten plans: national plans that operate in most surveyed states and regional plans that operate in one or a few states. Tables were provided to AHIP in a format that did not identify survey respondents or associate data with a specific plan. Dyckman used a conservative approach to the data that excluded high charge outliers that may reflect billing or coding errors.