Table 3.
Comparison of true† versus claims-derived†† measures when both sources indicated that in-network inpatient coinsurance was required
| Carve-in plan-years | Carve-out plan-years | |||
|---|---|---|---|---|
| % Total |
Among plans in row: Mean difference (SD) |
% Total |
Among plans in row: Mean difference (SD) |
|
| In-Network Inpatient Coinsurance | N=2074 | N=838 | ||
| Plan-year value derived from the minimum value observed in claims | ||||
| Derived < true | 82 | −15(7) | 66 | −14 (7) |
| Derived = true | 17 | 0(0) | 34 | 0 (0) |
| Derived > true | 1 | 18(22) | 0 | NA |
| Plan-year value derived from the 25th percentile value observed in claims | ||||
| Derived < true | 76 | −12(7) | 64 | −14 (7) |
| Derived = true | 23 | 0(0) | 36 | 0 (0) |
| Derived > true | 1 | 18(22) | 0 | NA |
| Plan-year value derived from the 50th percentile value observed in claims | ||||
| Derived < true | 57 | −9(6) | 55 | −10 (6) |
| Derived = true | 42 | 0(0) | 45 | 0 (0) |
| Derived > true | 1 | 14(17) | 0 | NA |
| Plan-year value derived from the 75th percentile value observed in claims | ||||
| Derived < true | 29 | −7(5) | 35 | −8 (5) |
| Derived = true | 69 | 0(0) | 65 | 0 (0) |
| Derived > true | 3 | 17(16) | 0.1 | 14 (0) |
| Plan-year value derived from the maximum value observed in claims | ||||
| Derived < true | 18 | −7(5) | 27 | −8 (5) |
| Derived = true | 64 | 0(0) | 73 | 0 (0) |
| Derived > true | 18 | 22(18) | 0.5 | 18 (9) |
| In-Network Outpatient Professional Coinsurance | N=2218 | N=2259 | ||
| Plan-year value derived from the minimum value observed in claims | ||||
| Derived < true | 94 | −18(5) | 87 | −18 (4) |
| Derived = true | 5 | 0(0) | 13 | 0 (0) |
| Derived > true | 0.4 | 19(7) | 0 | NA |
| Plan-year value derived from the 25th percentile value observed in claims | ||||
| Derived < true | 84 | −17(6) | 73 | −18 (4) |
| Derived = true | 16 | 0(0) | 27 | 0 (0) |
| Derived > true | 1 | 17(7) | 0 | NA |
| Plan-year value derived from the 50th percentile value observed in claims | ||||
| Derived < true | 56 | −17(6) | 43 | −17 (5) |
| Derived = true | 43 | 0(0) | 57 | 0 (0) |
| Derived > true | 1 | 20(10) | 0 | NA |
| Plan-year value derived from the 75th percentile value observed in claims | ||||
| Derived < true | 21 | −15(7) | 16 | −17 (6) |
| Derived = true | 76 | 0(0) | 84 | 0 (0) |
| Derived > true | 3 | 22(16) | 0 | NA |
| Plan-year value derived from the maximum value observed in claims | ||||
| Derived < true | 3 | −6(4) | 2 | −9 (6) |
| Derived = true | 58 | 0(0) | 98 | 0 (0) |
| Derived > true | 39 | 29(21) | 0.1 | 14 (22) |
SD: Standard deviation; INN: In-network
†:
True measures are drawn from an insurer’s claims processing engine database, and reflect the values present in the “Description of Benefits” documents issued by the insurer.
††:
Claims-derived measures are based on expenditures from coinsurance in specialty mental health claims data.