HealthLeaders Media September 23, 2022
Analysis of price transparency data suggests better information on health insurance exchange plans (HIX) is needed.
KEY TAKEAWAYS
– The 16 insurers in the study with both HIX and commercial group plans paid providers for their HIX enrollees 88.6% of their commercial group rate for inpatient services and 88.9% for outpatient services.
– The 19 insurers with both HIX and MA plans paid providers for HIX enrollees 143.3% of their MA enrollees for inpatient services and 243.6% for outpatient services.
– The price discrepancy was attributed to the HIX plans’ narrow networks and hospitals’ willingness to accept lower rates for HIX plans to recoup on unpaid bills from less-affluent HIX enrollees.
Payers generally negotiate lower amounts for HIX plans than...
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