Involuntary Use of Out-of-Network Physicians in Private Health Plans



This program is for the research community.


Health insurance plans that provide reimbursement for out-of-network services are popular, providing enrollees with greater physician choice, but at higher cost-sharing and additional costs due to balance billing. However, there is increasing interest among policymakers in the issue of involuntary use of out-of-network physicians, especially in the inpatient setting. Despite recent legislative activity at federal and state levels, little is known about the scope of this issue. Using survey methods, we aimed 1) To determine the percent of privately insured individuals who used an out-of-network physician in the last year, 2) To determine how much out-of-network use was involuntary, and 3) To describe the characteristics of individuals using out-of-network physician services (i.e., health status, income) and the types of services used (i.e., inpatient versus outpatient).

Date & Time(s)


Memorial Sloan Kettering Cancer Center
1275 York, Avenue, Room M-107
New York, NY 10065


Center for Health Policy and Outcomes


Kelly Kyanko, MD
Robert Wood Johnson Clinical Scholar
Yale School of Medicine