According to a recent paper by Kyanko, Curry and Busch (2003), 8 percent of insured individuals used an out-of-network physician.
Why are people using out-of-network services? The authors give the following breakdown.
Approximately 40 percent of individuals using out-of-network physicians experienced involuntary out-of-network care. Whereas fifteen percent of outpatient out-of-network contacts were involuntary, almost 60 percent of inpatient out-of-network contacts were involuntary.
Another problem with using out-of-network providers is that patients were not sure what cost they would incur. The authors write:
We also found a lack of cost transparency for out-of-network services. For over half of inpatient contacts and approximately 40 percent of outpatient contacts, the patient did not know how much they would have to pay before receiving care. One third of individuals using out-of-network services reported not having enough information about the costs of using an out-of-network physician…Our results suggest that involuntary care and lack of cost transparency in out-of-network physician services are attributable to encounter characteristics and system-level failures rather than individual patient health literacy. Lower educational attainment was not associated with increased involuntary out-of-network use or lack of cost transparency.
- Kyanko, K. A., Curry, L. A. and Busch, S. H. (2013), Out-of-Network Physicians: How Prevalent Are Involuntary Use and Cost Transparency?. Health Services Research, 48: 1154–1172. doi: 10.1111/1475-6773.12007