82 / 537
Employer Group ABC
Incurred:
Apr 2014 thru Dec 2015
Paid:
Apr 2014 thru Mar 2016
19
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Page
Figure 3.1.2 shows the cost distribution by city and state for the members utilizing out-of-network providers. Efforts
to move utilization in-network should begin with an understanding of why members located in these cities are seeing
out-of-network (OON) providers.
Figure 3.1.2 Top 10 Zip Codes for Out-of-Network Claims Paid
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OON Spend
$ in Thousands
OON
Spend
all OON
Spend
$4,718.71
7.3%
3.5%
$608.50
21.5%
0.5%
$228.08
28.1%
0.2%
$188.58
47.0%
0.1%
$149.73
1.3%
0.1%
$98.44
7.0%
0.1%
$80.77
32.6%
0.1%
$57.59
11.8%
0.0%
$56.88
3.7%
0.0%
$55.19
9.9%
0.0%
Total = $6.24 M
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Source: Medical Intelligence : Network Utilization Module / Drill by Zip / Top 10 Zip codes based on NON PAR Paid