Kaiser report finds 20% of inpatient billing includes out-of-network charges. Do companies like GM and Disney realize this?

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The number of companies going direct to providers and bypassing health plans in 2019 will be almost four times as many as the number who did so in 2018. That is an incredible jump. Companies going direct in 2018 comprised 3%, while in 2019, that number is expected to reach 11%.[1]

Companies cannot afford to continue to pay for exorbitant healthcare costs for their employees. Sadly, employees can’t keep up either, even when charges come from in-network providers. Imagine the financial burdens placed on employees – and their employers – when they find out, after the fact, that they were actually given service from an out-of-network provider when they thought they were in-network.

Huh? Exactly. These days it’s hard to know when you’re in- or out-of-network, even when you are admitted to the hospital via the ER in a hospital that is supposedly in your network. In an astounding study just released by the Kaiser Family Foundation, “among people with employer coverage, nearly one in five inpatient admissions includes a claim from an out-of-network provider.”[2]

The study provides several eye-opening statistics[3]:

  • Almost 20% of inpatient admissions includes a claim from an out-of-network provider
  • 4% – the share of inpatient admissions with a claim from an out-of-network provider remains significant even when enrollees use in-network facilities for care

The study also found that the reason for inpatient admissions is a large factor in a patient receiving a claim from a non-network provider.[4] So, people who suffer from psychological and substance abuse are three times more likely to receive a claim from an out-of-network provider than people who are in the hospital to have a baby. For instance:

  • 33.5% of out-of-network claims for inpatient services are for psychological and substance abuse
  • 20.3% are for surgical reasons
  • 18.9% are for medical reasons
  • 11.1% are for childbirth and newborns

Wouldn’t it be nice if there was a win-win solution to keep people in-network when they are inpatient for any treatment? Wouldn’t it be nice if employers, employees and providers could benefit? Surprise billing is hard on everyone. Providers are trying to help with patient portals, but portals do not offer the infrastructure that a complete e-commerce solution provides.

There is a solution and an infrastructure ready to go, today, that can keep these types of claims and surprise bills from happening and it is HealthQRS.

HealthQRS can help providers expand their offerings, which in turn helps people receive the services they need at a price they – and their employers – can afford. For example, we enable telehealth services which can provide access to in-network behavioral health.

HealthQRS’ offers a complete e-commerce platform, and we are the only system that provides the full ecommerce platform that works with all parties involved. This helps employers and employees lower costs by keeping people in network because the only option within our system would be in-network.

We can even provide bundled billing so that there are no separate bills and no out-of-network surprises. HealthQRS’ e-commerce solution helps providers, self-insured companies and their employees.

We collect and track data on appointments, procedures, amount paid, and much more. Every touchpoint with the transaction is captured by our system, so we can provide extremely rich reporting on every aspect of what the consumer is doing as well as how it touches your hospital system and the employer’s business. This gives the you – and the employer the infrastructure and reporting to see what the actual cost savings are. Our analytics show actual numbers, not estimates.

We are a software-as-a-service (SaaS), so you have no capital investment, just a low monthly fee. We also have a smartphone application that consumers can use to shop, see actual costs, schedule and pay for services with a few finger taps.

Our e-commerce medical marketplace platform is the perfect vertical application for integrated delivery networks. Our solution provides regulation compliance and serves as a marketing tool for your services. At the same time, we will solve your bad debt issues caused by not collecting from consumers, and many other benefits. In addition, HealthQRS allows you to be compliant with the new CMS transparency rules beginning Jan. 1, 2019.

HealthQRS can also enhance your existing portals and other patient engagement solutions. Our user-friendly app points them to your portals which will improve your meaningful use numbers and increase meaningful use funds.

HealthQRS has over 15 years of experience developing healthcare retail experiences for people and our founders have over 50 combined years of e-commerce experience. We invite you to watch our user-friendly app video that you can use to win consumers. We also have a point-of-service solution video that may interest you. You can also check out our E-Commerce Medical Marketplace Flyer for more information. Why not contact us right now to schedule a personalized demo? We’re ready to help you gain market share and secure your financial outlook.


[1] Emerman, “Large U.S. Employers,” National Business Group on Health Press Release, Aug. 7, 2018, https://www.businessgrouphealth.org/news/nbgh-news/press-releases/press-release-details/?ID=348

[2] Gary Claxton, Matthew Rae, Cynthia Cox and Larry Levitt, “An analysis of out-of-network claims in large employer health plans,” Peterson-Kaiser Health System Tracker, Kaiser Family Foundation, https://www.healthsystemtracker.org/brief/an-analysis-of-out-of-network-claims-in-large-employer-health-plans/#item-start

[3] Claxton, et al, “An analysis of out-of-network claims,” Peterson Kaiser, Aug. 13, 2018, https://www.healthsystemtracker.org/brief/an-analysis-of-out-of-network-claims-in-large-employer-health-plans/#item-start

[4] Claxton, et al, “An analysis of out-of-network claims,” Peterson Kaiser, Aug. 13, 2018, https://www.healthsystemtracker.org/brief/an-analysis-of-out-of-network-claims-in-large-employer-health-plans/#item-start

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