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Experience with New York's Arbitration Process for Surprise Out-of-Network Bills
The Brookings Institution Link to more items from this source
Oct. 24, 2019

"The biggest concern raised about NY's arbitration process is the state's guidance that arbiters should consider the 80th percentile of billed charges ... when determining the final payment amount. Providers' billed charges, or list prices, are unilaterally set, largely unmoored from market forces, and generally many times higher than in-network negotiated rates or Medicare rates. And telling arbiters to focus on 80th percentile of charges -- that is, an amount higher that what 80% of of physicians charge for a given billing code -- drives this standard still higher."

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