Study: Surprise Medical Bills Increase in Cost and Frequency

Potential financial consequences from out-of-network billing nearly double for emergency room visits and inpatient care—leaving some patients facing more than $1,000 in unexpected bills.

9/9/2019 8:00 AM

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Study: Surprise Medical Bills Increase in Cost and Frequency

More patients are seeing out-of-network bills and at higher costs, even when they visit hospitals in their insurance network, according to a study published in JAMA Internal Medicine. The researchers sought to fill in gaps in data on the incidence of surprise out-of-network bills and their financial consequences as the issue continues to gain media attention and that of lawmakers on Capitol Hill seeking to regulate the billing practices between health care providers and insurers.

“Out-of-network billing appears to have become common for privately insured patients even when they seek treatment at in-network hospitals. The mean amounts billed appear to be sufficiently large that they may create financial strain for a substantial proportion of patients,” the researchers conclude. “Overall, our findings suggest a growing risk to patients of incurring burdensome unexpected out-of-network bills.”

Such bills for emergency room visits increased from 32.3% to 42.8% between 2010 and 2016, Stanford University researchers found after analyzing 13.6 million emergency department admissions in that time frame, according to the study, “Assessment of Out-of-Network Billing for Privately Insured Patients Receiving Care in In-Network Hospitals.”

And, by analyzing 5.6 million inpatient admissions, they found out-of-network billing increased from 26.3% to 42% and the mean potential financial liability for those patients increased from $804 to $2,040. Potential financial liability for emergency room patients increased from $220 to $628, according to the study.

The costs result from balance billing, or surprise medical bills, that occur when a patient receives a bill from a health care provider to pay the difference between the provider’s charges and the amount covered by their insurance plan; often resulting from a patient receiving care from a provider out of their network. This happens in emergency situations or when a health care professional, such as a radiologist, who is not part of a patient’s network provides care at hospital in their insurance network—unbeknownst to the patient.

During the study period, researchers found 37% of the inpatient admissions (about two million) led to at least one out-of-network bill. Approximately 32.6% of patients cared for in the emergency room received an out-of-network bill.

Patients in the emergency room often see out-of-network bills as a result of ambulance transport, for example, since 85.6% received a bill for that alone, according to the study. About 81% of patients admitted to the hospital received a bill for ambulance transport.

Meanwhile on Capitol Hill, the bipartisan efforts to pass legislation prohibiting balance billing and limit patient expenses for emergency care to their in-network rates, for example, face opposition from doctors and hospitals.

The Hill reports bipartisan members of the House and Senate support the legislation to target health care costs; but opposition from doctors and hospitals continues due to the possible “damaging cuts in payments” that could result from legislation.

Related Content from ACA International:

Texas Enacts Health Care Measures Impacting Credit Reporting and “Surprise” Medical Billing

House Health Subcommittee Takes on Surprise Medical Bills


Follow ACA International on Twitter @ACAIntl and @acacollector, Facebook and request to join our LinkedIn group for news and event updates. ACA International members are welcome to submit news items for possible publication to comm@acainternational.org. Visit our publications page for news submission guidelines and subscriptions to ACA Daily, Collector magazine and Pulse.

Advertising is available for companies wishing to promote their products or services. Be sure to visit the ACA Events Calendar on the Education and Training page to view our listing of upcoming CORE Curriculum and Hot Topic seminars featuring critical educational opportunities for your company.


Subscribe to ACA Daily NEWSROOM

Study: Surprise Medical Bills Increase in Cost and Frequency

More patients are seeing out-of-network bills and at higher costs, even when they visit hospitals in their insurance network, according to a study published in JAMA Internal Medicine. The researchers sought to fill in gaps in data on the incidence of surprise out-of-network bills and their financial consequences as the issue continues to gain media attention and that of lawmakers on Capitol Hill seeking to regulate the billing practices between health care providers and insurers.

“Out-of-network billing appears to have become common for privately insured patients even when they seek treatment at in-network hospitals. The mean amounts billed appear to be sufficiently large that they may create financial strain for a substantial proportion of patients,” the researchers conclude. “Overall, our findings suggest a growing risk to patients of incurring burdensome unexpected out-of-network bills.”

Such bills for emergency room visits increased from 32.3% to 42.8% between 2010 and 2016, Stanford University researchers found after analyzing 13.6 million emergency department admissions in that time frame, according to the study, “Assessment of Out-of-Network Billing for Privately Insured Patients Receiving Care in In-Network Hospitals.”

And, by analyzing 5.6 million inpatient admissions, they found out-of-network billing increased from 26.3% to 42% and the mean potential financial liability for those patients increased from $804 to $2,040. Potential financial liability for emergency room patients increased from $220 to $628, according to the study.

The costs result from balance billing, or surprise medical bills, that occur when a patient receives a bill from a health care provider to pay the difference between the provider’s charges and the amount covered by their insurance plan; often resulting from a patient receiving care from a provider out of their network. This happens in emergency situations or when a health care professional, such as a radiologist, who is not part of a patient’s network provides care at hospital in their insurance network—unbeknownst to the patient.

During the study period, researchers found 37% of the inpatient admissions (about two million) led to at least one out-of-network bill. Approximately 32.6% of patients cared for in the emergency room received an out-of-network bill.

Patients in the emergency room often see out-of-network bills as a result of ambulance transport, for example, since 85.6% received a bill for that alone, according to the study. About 81% of patients admitted to the hospital received a bill for ambulance transport.

Meanwhile on Capitol Hill, the bipartisan efforts to pass legislation prohibiting balance billing and limit patient expenses for emergency care to their in-network rates, for example, face opposition from doctors and hospitals.

The Hill reports bipartisan members of the House and Senate support the legislation to target health care costs; but opposition from doctors and hospitals continues due to the possible “damaging cuts in payments” that could result from legislation.

Related Content from ACA International:

Texas Enacts Health Care Measures Impacting Credit Reporting and “Surprise” Medical Billing

House Health Subcommittee Takes on Surprise Medical Bills


Follow ACA International on Twitter @ACAIntl and @acacollector, Facebook and request to join our LinkedIn group for news and event updates. ACA International members are welcome to submit news items for possible publication to comm@acainternational.org. Visit our publications page for news submission guidelines and subscriptions to ACA Daily, Collector magazine and Pulse.

Advertising is available for companies wishing to promote their products or services. Be sure to visit the ACA Events Calendar on the Education and Training page to view our listing of upcoming CORE Curriculum and Hot Topic seminars featuring critical educational opportunities for your company.


Subscribe to ACA Daily NEWSROOM

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