‘Surprise’ Out-Of-Network Bills After In-Network Elective Surgery

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, FEBRUARY 11, 2020

Media advisory: To contact corresponding author Karan R. Chhabra, M.D., M.Sc., email Kara Gavin at kegavin@med.umich.edu. The full study and related articles are linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2019.21463?guestAccessKey=9774a0bf-c1e7-45a4-b2a0-32f41c6fde66&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=021120

 

Bottom Line: Claims data from a large health insurer were used to examine how often patients unexpectedly receive out-of-network bills after having in-network elective surgery.  These “surprise bills” typically occur when a patient receives care from a clinician, such as an anesthesiologist or surgical assistant, who doesn’t participate in that patient’s insurance network. This analysis included nearly 350,000 commercially insured patients who underwent elective surgery at in-network facilities with in-network primary surgeons between 2012 and 2017. The authors report that approximately 1 in 5 of these procedures resulted in an out-of-network bill, with an average potential balance of $2,011. Out-of-network bills were associated with anesthesiologists and surgical assistants in 37% of these surgeries. A limitation of the study is that claims data came from only one insurer.

Authors: Karan R. Chhabra, M.D., M.Sc., University of Michigan, Ann Arbor, and coauthors.

 

(doi:10.1001/jama.2019.21463)

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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