Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Payment
February 11, 2020 11:00 AM

Study finds 1 in 5 patients gets surprise bills for elective surgeries

Rachel Cohrs
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Modern Healthcare Illustration / Getty Images

    Patients who schedule elective surgery at an in-network facility with an in-network primary surgeon are often subjected to surprise medical bills because other members of the surgical teams were out-of-network, a study published Tuesday shows.

    The trend extended to states that had passed laws aimed and protecting patients from surprise medical bills. And it comes as debate in Congress is heating up again over how federal lawmakers can best curtail the problem.

    Researchers at the University of Michigan and a student at Harvard Medical School found that 20.5% of patients who underwent one of seven common elective surgeries received a surprise medical bill, according to claims data from a major health insurer for January 2012 through September 2017. The research, published in JAMA, shows that balance billing could also be prevalent in non-emergency settings.

    "This is in contrast to prior research on emergency care, which pointed toward a subset of emergency departments staffed by private equity-backed medical groups as the primary source of out-of-network billing," the authors wrote.

    The average amount of a surprise bill was $2,011. Out-of-network surgical assistants were present in 37% of the balance-billing instances, and associated bills were an average of $3,633. Anesthesiologists also were involved in 37% of balance-billing situations, and the average surprise bill was $1,219.

    Though states such as California, Connecticut, Florida, Illinois, Maryland, Massachusetts, Mississippi and New York have enacted varying laws protecting patients from surprise medical bills, all had proportions of surprise billing above the national median for elective surgery with an in-network facility and primary surgeon.

    "This suggests several hypotheses, including that these states may have been responding to endemic surprise billing problems, and that these policies may not have been completely effective," the study authors wrote.

    Federal surprise billing proposals currently take different approaches to address surprise bills for elective procedures.

    The House Ways & Means proposal would require plans to provide enrollees with an explanation of benefits, including a cost estimate, for services scheduled at least three days in advance.

    Hospitals and providers have started to line up behind the Ways & Means bill. The American Hospital Association, Federation of American Hospitals, Greater New York Hospital Association and American College of Emergency Physicians have made supportive statements about the bill. American Society of Anesthesiologists President Dr. Mary Dale Peterson said the group is "certainly interested" in the proposal.

    Compromise legislation from the House Energy & Commerce Committee and Senate health committee would ban some out-of-network providers at in-network facilities from balance billing unless the provider notifies the patient of network status and provides a cost estimate at least 72 hours in advance.

    Insurers and employers generally would prefer an approach addressing surprise medical bills similar to the one taken by the House Energy & Commerce Committee, though they do not like that an arbitration process was included for claims with an in-network payment of at least $750.

    Several factors affected patients' risk of receiving a surprise medical bill, according to the JAMA study. Enrollees in exchange health insurance plans were more likely to be surprise billed than those in non-exchange plans because exchange plans generally have narrower physician networks; those with surgical complications were also likely to face surprise medical bills. Balance bills also varied state-by-state, ranging from a 3% incidence rate in Nebraska to 46% in Alaska.

    The JAMA study authors were Dr. Karan Chhabra, Dr. Kyle Sheetz, Ushapoorna Nuliyalu, Mihir S. Dekhne, Andrew Ryan, and Dr. Justin Dimick.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    wegovy
    Insurers, PBMs restrict access to weight loss drugs as demand soars
    CarbonHealth_Reception_1.jpg
    California contract dispute mirrors national trends
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Daily Finance Newsletter: Sign up to receive daily news and data that has a direct impact on the business and financing of healthcare.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing