Even patients who plan their elective surgeries ahead of time — using in-network surgeons at in-network facilities — can receive unforeseen bills from out-of-network providers, according to a new study published Tuesday in JAMA.
Reviewing the files on nearly 350,000 patients with commercial insurance who underwent common elective surgeries such as hysterectomies and coronary artery bypass grafts, researchers found that about 20% were hit with out-of-network charges. The average outstanding balance on these so-called surprise medical bills was $2,011.
Why the bills occur: Surprise bills came most frequently from surgical assistants and anesthesiologists, who are typically not selected by the patient. Patients with insurance plans purchased on the health insurance exchanges also had an increased risk of receiving out-of-network bills.
What it means for patients: “The study highlights how common surprise billing is, even in a context where consumers may have an illusion of control over what they will have to pay,” says NPR’s Elena Renken. “For elective surgeries, patients often have time to select in-network providers, but it didn't appear to make a difference.”
A call to act: In an editorial published in JAMA Tuesday, Drs. Karen Joynt Maddox and Edward Livingston called on doctors and lawmakers to address the problem, citing the ethical obligations of the medical profession. “Patients generally select surgeons because they have faith that the surgeon they choose will provide them with the best possible care,” they wrote. “This crucial trust between patient and physician will be eroded if patients discover after an operation that they must pay large sums of money to other clinicians the surgeon has involved in their care. When feasible, surgeons should ensure that all the personnel involved in the care team that they are leading accept the same insurance plans and should consider refusing to work in facilities that allow surprise billing.”
Congress may – or may not – act: Legislation that would regulate surprise bills was under consideration last year and lawmakers from both parties say they want to do something about the problem. But powerful lobbying groups representing the divergent interests of insurers, hospitals and physicians have pushed for different kinds of solutions, and no compromise has yet been reached.
Jean Fuglesten Biniek, a senior researcher at the Health Care Cost Institute, told NPR that Congress could make a deal this year. "It's a rare case where both parties in Congress want to get something done, and we have examples of what a bipartisan agreement might look like," she said. "Just getting that far can often be difficult in health policy. I'm hopeful that they will take action."
