This project is funded under the Robert Wood Johnson Foundation’s research program, “Health Data for Action (HD4A),” which makes valuable data from unique data owners available to researchers to answer important research questions. The goal of the study is to describe the effects of surprise billing protections, including what effects, if any, these laws have on in-network pricing. Using Health Care Cost Institute (HCCI) data and supplementary data sources on state balance billing laws the researchers will examine two research questions: (1) what are the effects of recent state surprise billing laws on outcomes among fully insured enrollees; and (2) what are the "spill-over" effects of state surprise billing laws on self-insured plan enrollees. Using a natural, quasi-experimental design, the researchers will separately measure outcomes of interest (occurrence of surprise billings, total allowed payments to out-of-network (OON) providers, charges by OON providers, and in-network prices) in various surprise billing situations: OON emergency department facilities, OON clinicians at in-network facilities, and OON ground ambulances. Deliverables will include a project work plan, final narrative, and financial reports. The researchers will also produce paper(s) suitable for publication and present findings at national research meetings and to other stakeholder audiences as appropriate, including policymakers at the federal, state, and local levels and other key stakeholders, as part of the deliverables for this grant.

Grant #78955
Grantee Organization: The Ohio State University
Grantee period: 12/1/2021– 11/30/2022
Budget: $100,000

Principal Investigator:

Wendy Xu
Committee Member, Member, Researcher

Wendy Xu, Ph.D.

Associate Professor - Division of Health Services Management and Policy, College of Public Health, Ohio State University

Dr. Wendy Xu is an Associate Professor at the Division of Health Services Management and Policy, College of Pu... Read Bio