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Ohio State Study Finds Out-Of-Network Costs Soaring For Insured Patients

The James Cancer Hospital at the Ohio State University Wexner Medical Center.
Ohio State University Wexner Medical Center

Ohio State University researchers have found that Americans with health insurance are paying soaring prices for out-of-network care. 

The study, published in December in the American Journal of Managed Care, examined claims from 2012-2017 from more than 22 million enrollees in private health insurance plans. Researchers found that out-of-pocket costs for non-emergency care at out-of-network hospitals rose dramatically in five years.

The fastest price increases came from non-emergency hospitalizations.

"The adjusted out-of-pocket spending grew from 2012 to 2017 from $671 to 1268. So it's almost doubling," says Ohio State assistant professor Wendy Xu, the study’s lead author.

For emergency hospitalizations out-of-network, consumer costs increased from $452 to $565.

Researchers say patients should be told if providers and facilities are not in their plan, regardless of the urgency of their illness. And they would like to see state re-examine the criteria of what makes a network large enough to meet patients' needs.

“Patients should really not be held against the extra costs especially in the situations when they actually did not know or give their consent using out-of-network," Xu says.