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Analysis of Large Employer Plans Claims Data Finds Higher Incidence of Surprise Medical Bills for Hospital Stays and Emergency Visits

An analysis of claims data from large employer plans to estimate the incidence of out-of-network charges associated with hospital stays and emergency visits that could result in a surprise bill found that millions of emergency visits and hospital stays put people with large employer coverage at risk of receiving a surprise bill. The analysis was undertaken by Peterson Center on Healthcare and KFF. The analysis found for people in large employer plans, 18% of all emergency visits and 16% of in-network hospital stays had at least one out-of-network charge associated with the care in 2017.

Researchers also examined state and federal policies aimed at addressing the incidence of surprise billing. Their analysis found a high degree of variation by state in the incidence of potential surprise billing for people with large employer coverage, who are generally not protected by state surprise billing laws if their plan is self-insured. For people with large employer coverage, emergency visits and in-network inpatient stays are both more likely to result in at least one out-of-network charge in Texas, New York, Florida, New Jersey, and Kansas, and less likely in Minnesota, South Dakota, Nebraska, Maine, and Mississippi.

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