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Reference Pricing and Network Adequacy Standards: Conflict or Concord?
Health Affairs Link to more items from this source
[Opinion]
Sept. 18, 2014

"[R]ecent federal guidance ... blurs the distinction between in-network and out-of-network providers and may make it more difficult for regulators and consumers to understand the effective 'size' of a particular network. This confusion could undermine the goal of improving transparency in consumers' health care choices and make it difficult for consumers to use prices in choosing providers. More troubling, expanded use of 'reference pricing' under the guidance could leave patients paying unexpectedly large out-of-pocket amounts for services provided by ostensibly in-network providers."

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