Surprise OON billing and benchmarking costs to 125% of medicare rates


Staff member
Aug 8, 2019
Gilbert, AZ
I just read this article at Health Affairs and was shocked/concerned to read this:

"Most importantly, Congress should establish a locally based benchmark to determine the amount an insurer would be required to pay a provider for a surprise bill. Ideally, we’d set the benchmark at some multiple (for example 125 percent) of what Medicare pays to correct for market failures...Benchmarks are predictable and fair. Depending on how they are designed, benchmarks could create downward pressure broadly on commercial health care prices, encouraging more providers to come in-network. Setting a benchmark at 125 percent of Medicare would avoid locking in excessive commercial rates indefinitely and slow the rate of future price growth, since the benchmark would be indexed to Medicare."

I don't do any out OON billing but we all know how disastrous medicare reimburses anesthesia...I would have to indefinitely defer my student loans!