A JAMA Health Forum study found that nearly one in five privately insured families with in-network child deliveries received potential surprise bills for maternal or newborn care in 2019.
Using information from Optum's Clinformatics Data Mart—a database composed of more than 12 million privately insured enrollees nationwide—researchers analyzed 95,384 families, nearly 18,000 of whom had one or more potential surprise bill for delivery, newborn hospitalization, or both.
"Because childbirth is the number one reason for hospitalization, and because the frequency of out-of-network care seems to be so high according to our research, we suspect that childbirth is probably the number one reason for hospitalization-related surprise bills," said Kao-Ping Chua, lead author of the study and assistant professor of pediatrics at the University of Michigan Medical School.
Similar studies have found that on average, 18% of emergency department visits result in at least one surprise bill.
The recent research predicts that the revised version of the No Surprises Act, which will be enacted Jan. 1, 2022, will benefit patients as a necessary form of protection from resource-intensive hospitalization costs.
Out of potential surprise bills for deliveries, he said anesthesia given during vaginal birth and cesarean delivery comprised 16.3% and 14.2% of claims respectively.
For newborn hospitalizations, neonatal intensive care amounted to 19.4% of claims for potential surprise bills.
The median total liability among families for potential surprise bills was $744. For 35.8% of families, total liability after typical in-network reimbursement exceeded $2000.
Rena Conti, associate professor at Boston University's Questrom School of Business and co-author of the study applauded the recent federal moves to ban surprise billing. She noted how patients can't take the time to choose an in-network provider when their water breaks or while in the middle of a delivery. Conti said it's not just a concern for select families, services or hospitals, but rather a symptom of systematic healthcare failure.
"It's great that the No Surprises Act is going to protect families against liability for potential surprise bills, but we can't let that stop us advocating for better insurance coverage designed for childbirth," Chua said.
CMS' interim final rule, released on Thursday, follows the No Surprises Act in banning surprise billing for emergency services while also stopping surprise out-of-network charges for ancillary services like those provided by anesthesiologists or assistant surgeons.
While patients won't be billed more than in-network cost-sharing amounts, it is uncertain what the overall impact of the No Surprises Act will be on healthcare providers and payers, said Adam Block, an assistant professor at New York Medical College.
He said the actual price of services will be decided by an independent arbitrator, and whether they lean toward lower or higher prices will likely determine whether health plans allow more or less providers to go out of network.
While lower costs could lead to a reduction in insurance premiums, overall there shouldn't be a significant detrimental effect on health insurance operations as they have had time to prepare for this legislation, said Brad Ellis, senior director of insurance at Fitch Ratings.
The No Surprises Act will hopefully address physician issues, especially for those who were dropped from payer networks, said Mary Peterson, immediate past president of the ASA.
Peterson said anesthesiologists must be able to negotiate fair payment for their work based on commercial rates, regardless of whether or not they are in network. Insurance companies should also feel like they are paying a fair amount, she said.
Emergency physicians and other providers are hoping the finalized arbitration process will not involve high fees for claims or undue administrative burden to figure out out-of-network costs, said Laura Wooster, associate executive director of public affairs at ACEP.
