"根据"没有惊喜法"对网络外医疗账单的仲裁结果"
Benjamin Ukert1, Aliza S Gordon2
1Texas A&M University, College Station, TX, USA.
概括
根据"无惊喜法" (NSA) 的仲裁程序,网络之外的供应商通常会收到比网络内的费率高得多的付款. 这项研究发现仲裁和解比预期的要高得多,这与最初的预测相反.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 医疗账单计费 医疗账单计费
背景情况:
- 无惊喜法 (NSA) 的目的是保护患者免受意外的医疗费用.
- 在国家安全局 (NSA) 下进行网络外护理的仲裁可能会导致高成本.
- 该法案的仲裁程序旨在解决保险公司和提供商之间的争议.
研究的目的:
- 分析通过NSA仲裁解决的网络外护理支付.
- 为了比较仲裁结算金额与网络内价格以及合格支付金额 (QPA).
主要方法:
- 分析了2023年Elevance Health提供的7076个争议和索赔数据.
- 对保险公司和提供商的报价,结算金额,QPA,网络价格和医疗保险费率进行比较.
- 在国家安全局仲裁中产生的支付的特征.
主要成果:
- 提供商赢得了80%的分析争端.
- 仲裁和解的中位数是QPA的3.72倍和网络中的2.04倍.
- 结算金额远高于QPA和网络价格,是医疗保险费用的4.5倍.
结论:
- 美国国家安全局的仲裁结算远远超过预期的网络价格.
- 网络之外的供应商通过仲裁获得的付款比网络内供应商高得多.
- 调查结果与国会预算办公室对仲裁节省预测形成鲜明对比.
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