Comparison of Estimated No Surprises Act Qualifying Payment Amounts and Payments to In-Network and Out-of-Network Emergency Medicine Professionals

ABSTRACT: This cross-sectional study compares in-network and out-of-network payments with qualifying payment amount estimates to assess potential implications of the No Surprises Act on private insurance reimbursements for emergency medicine clinicians. Key Points

Question

How do qualifying payment amount (QPA) estimates under the No Surprises Act (NSA) compare with in-network and out-of-network payments for emergency medicine services before NSA implementation?

Findings

In this cross-sectional study of 7 556 541 US commercial insurance claims, mean in-network and out-of-network payments were 14% and 112% higher than QPA estimates, respectively. Mean out-of-network payments were higher among self-funded plans than fully insured plans and among physicians vs nonphysicians.

Meani

SUBMITTER: Duffy E 

PROVIDER: S-EPMC9482054 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature