The highest percentage of specialty surprise claims came from anesthesiology, at 16 percent. Primary care represented 13 percent, and emergency medicine 11 percent. (Photo: Shutterstock)
A new study finds that one in seven patients are hit with a surprise medical bill—an out-of-network charge for a medical service—even though they were admitted to an in-network hospital.
The new analysis, from the Health Care Cost Institute (HCCI), looked at 620,000 patients across 37 states and the District of Columbia in 2016. “Overall, we found that 14.5 percent of these admissions had at least one associated out-of-network professional claim; that is, roughly 1 in 7 patients received a surprise bill despite obtaining care at an in-network hospital,” the report said.
The issue has raised confusion and controversy as patients who are treated at a hospital that is part of their insurance network receive bills for services provided by out-of-network practitioners or facilities. At a time when consumer engagement is promoted by health care providers and payers, these unexpected bills underscore how much of the health care delivery system is still not transparent.
|Geographic area makes a difference
The report noted that there was a wide range to the out-of-network charges, depending on the state. “In Florida, 26.3 percentage of the sample's in-network admissions had an associated surprise bill––the largest percentage of any state in the study,” the report said. “This was over 15 times greater than in Minnesota (1.7 percent of admissions), the state with the lowest prevalence.”
The study found 19 states that had between 10 and 19 percent of in-network admissions with services provided by out-of-network professionals. Six states had out-of-network claims with between 20 percent and 26 percent of inpatient hospital admissions.
One of the analysts, Kevin Kennedy, told Modern Healthcare that the numbers were striking, but the state-by-state comparisons could lead to solutions. “By showing state-by-state variation, maybe we can see what Minnesota is doing with the relationships between hospital and insurers and the legislation involved and how it compares to states like Florida or Kansas,” he said.
|Breaking down claims by specialty, frequency
The study also looked at which specialties had the largest share of out-of-network claims for in-network hospital admissions as a whole. It also looked at what percentage of claims from individual specialties fell under the surprise category.
The highest percentage of specialty surprise claims came from anesthesiology, at 16 percent. That was followed by an “other physician” category (14 percent), primary care (13 percent), and emergency medicine (11 percent).
Independent labs had the highest rates of claims that fell into the in-network admission/out-of-network claim category, at 22 percent of their total claims, followed by emergency medicine at 12 percent. Most other specialties were under 10 percent in this area.
|Surprise billing brings lawsuits, legislative proposals
The surprise billing issue has resulted in a number of lawsuits, and the issue has prompted legislative proposals on both the state and federal level.
There have been bipartisan bills introduced in Congress to address the issue in various ways, and the Trump Administration has vowed to fix the problem, according to National Public Radio.
“President Trump has identified surprise medical bills as a serious concern of the administration. Protecting patients from these outrageous and unexpected bills and charges is a top priority for Secretary [Alex] Azar,” Caitlin Oakley, a Department of Health and Human Services spokeswoman, said recently.
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