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Out-of-network coverage is disappearing

One reason surprise medical bills are going up: Coverage for out-of-network care is going down, according to the Robert Wood Johnson Foundation.

Why it matters: The burgeoning controversy over surprise hospital bills stems partly (though not exclusively) from the bills patients receive when they’re treated by an out-of-network provider — even without their knowledge, often within an in-network facility.

  • Out-of-network coverage has obviously never been as generous as in-network coverage (that’s the whole point of creating a network), but as insurers pull back even further, more patients will likely find themselves on the hook for even bigger bills.

Per RWJF:

  • Just 29% of insurance plans in the individual market provide any benefits for out-of-network providers. That’s down from 58% a mere three years ago.
  • Coverage is also declining in the market for small businesses, but not nearly as dramatically — 64% of small-group plans offer some out-of-network coverage, down from 71% in 2015.
  • Those small-group numbers are probably roughly in line with where things stand among large employers’ plans.
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