Each day, millions of Americans continue receiving surprise medical bills from private equity firms and out-of-network providers that can demand a blank check for their services. The problem is particularly egregious when patients do the due diligence to research the network status of their providers, hospitals and care team – only to learn after the fact that a specialist was involved in their care and surgical procedure. A recent report from researchers at the University of Michigan published in JAMA found that more than 20 percent of patients received an out-of-network charge that often exceeded $2,000 on average. Highlights from NPR’s coverage – Study: 1 In 5 Patients Gets A Surprise Medical Bill After Surgery – are included below:

  • “Tracking data from almost 350,000 patients with a large commercial insurer, the researchers found that more than 20% were hit with an out-of-network charge, according to a study released Tuesday in JAMA. The average bill was over $2,000 more than what insurance would typically pay.”
  • “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. Surprise bills are common after emergency care or nonsurgical hospital stays, when patients may not be able to choose health care providers covered by their insurance. (Twenty percent of inpatient admissions from the emergency department likely led to a surprise bill, a Health Affairs study found.) For elective surgeries, patients often have time to select in-network providers, but it didn’t appear to make a difference.”
  • “‘These are patients that actually choose their surgeon and their hospital, so it’s surprising that despite narrowing it down to people who have really done their homework, we still find the same rate [as for emergency care],’ says Dr. Karan Chhabra, the lead researcher on the investigation and a resident surgeon at Brigham and Women’s Hospital. The study found that most of the surprise bills come from either anesthesiologists or surgical assistants — who are typically not chosen by patients.”
  • “These new results reinforce the prevalence of the problem and align with earlier findings about surprise medical billing. A Kaiser Family Foundation analysis on data from 2017 found that about 1 in 6 patients get a surprise out-of-network bill after an emergency room visit or in-patient hospital stay.
  • They also paint a clearer picture of the problem. The rate of surprise billing ranges from 3% in Nebraska to 46% in Alaska. And people who bought individual insurance on the state and federal exchanges have higher than average rates of surprise billing — along with those who have at least one surgical complication, whose risk is 7 percentage points higher.”
  • “‘There are particularly vulnerable people out there, that might be even sicker or might not have that much money, and those people are the ones that are getting hit even harder,’ Chhabra says. ‘Those people might be the ones that are least able to cope with these bills.'”

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