A report from the Commonwealth Fund describes how seven states have adopted a payment standard for out-of-network bills based on different data sources: the Medicare fee schedule, which sets a reimbursement amount for each service; publicly available data from multiple insurers, like a state-run all-payer claims database; and insurers’ internal data on amounts they have agreed to reimburse in-network providers.
The report can be obtained at https://www.commonwealthfund.org/blog/2020/addressing-surprise-billing-setting-payment-standards-out-network-providers.