We’re Getting More Out-Of-Network Medical Bills, Even When We Choose In-Network Facilities

For years insurance companies and the government have told consumers to “shop around” when looking for medical care. Sometimes, like during an emergency, that’s not the first priority.  But still, many people identify the hospitals and other facilities that are considered in-network for their insurance, and choose accordingly.

A new study published in JAMA Internal Medicine suggests that it matters less than we think, because we still get smacked with big bills by out-of-network doctors, even at our in-network hospitals, and the numbers are getting worse.

The proportion of emergency room visits to in-network hospitals that result in out-of-network bills surged from 32.3% to 42.8% from 2010 to 2016, a 30% jump.

Over the same period, the proportion of inpatient hospital admissions to in-network hospitals that result in out-of-network bill surged from 26.3% to 42%.

The typical out-of-network bill has jumped almost 200% for ER visits, from $220 to $628, and 150% for inpatient hospital admissions, $804 to $2,040.

Dr. Eric Sun, lead author of the study and a researcher at Stanford University Medical Center in California, said:

“Out-of-network billing in both the inpatient and emergency room settings is common and has become more common over time.”

By email, he told Reuters:

“The amount of money involved can be a significant burden for many patients.  Even if they receive care at an in-network hospital, they may still face out-of-network bills.”

The problem is particularly acute for specialists, such as anesthesiologists.

About one-third of patients treated by emergency physicians at in-network hospitals got balance billed, the practice of out-of-network physicians sending extra bills after services are rendered, as did more than one in five patients receiving care from an internist or an anesthesiologist.

With inpatient admissions, specialties with the most balance billing included radiology, emergency medicine, internal medicine, anesthesiology, cardiology, pathology, ambulance transport, family practice, and obstetrics and gynecology.

The top 10% of balance bills for ER patients were more than $1,000, while those for inpatient admissions were more than $3,000.

The study didn’t investigate whether the bills were “surprises” or if the patients knew they were coming, but that’s beside the point.  When you go to an in-network provider, you expect the costs to be covered.

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  1. Jim Jaqua

    This is a common practice as specialists try to increase their income. The only solution is changing the regulations to eliminate the practice. That will not happen as donations to politicians might then decrease. I fear we are stuck with this billing practice.

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