Patients Receive Surprise Bills Even for In-Network Surgeries

A new study published in JAMA suggests that one-fifth of patients who receive elective surgeries at U.S. hospitals that accept their insurance still get surprise medical bills, especially if the procedure involves anesthesia.

Among almost 350,000 patients who underwent non-emergency surgery by surgeons who accepted their insurance at in-network hospitals and clinics between 2012 and 2017, 21% received out-of-network bills, which averaged more than $2,000.

“[Patients] might expect not to have any problems paying for care if they make sure their surgeon and the hospital are in-network. Our study shows that is not the case,” said Karan Chhabra, MD, of the University of Michigan Institute for Healthcare Policy and Innovation and Brigham and Women’s Hospital in Boston, who led the study.

In one-third of these cases, services from a surgical assistant or anesthesiologist were the source of the surprise bill. Often, while the primary surgeon accepted the patient’s insurance, the other clinicians did not. When surgical assistants were out-of-network, surprise bills averaged $3,633. They averaged $1,219 when the anesthesiologists did not accept the patient’s insurance.

Patients who purchased their insurance plans through health exchanges were slightly more likely to be surprised, receiving out-of-network bills 27% of the time compared with 20% of the time for those with other kinds of private health coverage. In addition, surgery complications increased the likelihood of getting surprise bills to 28%, compared with 20% in uncomplicated cases. However, the study only included data from one insurance company, which limits its implications.

Source: Reuters, February 11, 2020.