Analysis of Out-of-Network Billing of Privately Insured Patients at In-Network Hospitals

JAMA Internal Medicine


Media advisory: To contact corresponding author Eric Sun, M.D., Ph.D., email Beth Duff-Brown at The full study, editorial and viewpoint are linked to this news release.

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Bottom Line: An analysis of claims data for privately insured patients suggests out-of-network billing for inpatient admissions and emergency department (ED) visits to in-network hospitals has increased along with the patient financial liability associated with it. This study included 5.4 million inpatient admissions and nearly 13.6 million ED visits to in-network hospitals between 2010-2016. Of all the ED visits, 39.1% generated an out-of-network bill and 37% of all the inpatient admissions resulted in an out-of-network bill. The percentage of ED visits with an out-of-network bill increased from 32.3% to 42.8% during the study period and the percentage of inpatient admissions with an out-of-network bill increased from 26.3% to 42% during that same time.  The potential patient financial responsibility associated with out-of-network bills increased too, from an average $220 to $628 for ED visits and from an average $804 to $2,040 for inpatient admissions. A common example of out-of-network billing was ambulance transport. This study has some limitations, including no information on what patients actually paid to settle out-of-network bills. Researchers suggest their findings support strengthening legislative protections against the surprise medical bills associated with out-of-network billing.

Authors: Eric Sun, M.D., Ph.D., of Stanford University Medical Center in Stanford, California, is the corresponding author.



Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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