One-fifth of surgical patients who had in-network surgeons at in-network facilities received medical bills for out-of-network care, according to a study of insurance claims for 347,356 patients.
Researchers from the University of Michigan in Ann Arbor examined claims involving patients who had elective knee cartilage repair, total knee replacement, full or partial colon removal, gallbladder removal, breast lump removal, or coronary artery bypass graft surgery. The findings were published on JAMA Network.
Five takeaways:
1. Among 83,021 procedures performed at ASCs with in-network primary surgeons, 6.7 percent included an out-of-network facility bill and 17.2 percent included an out-of-network professional bill.
2. Overall, 20.5 percent of the operations resulted in an out-of-network bill. For cases that involved balance billing, the average charge was $2,011.
3. Out-of-network bills stemmed from care provided by surgical assistants in 37 percent of the cases. These episodes came with an average charge of $3,633.
4. Out-of-network bills were associated with anesthesiologists in 37 percent of operations, with an average balance bill of $1,219.
5. Patients who were members in health insurance exchange plans were at significantly higher risk of receiving an out-of-network bill. The risk was also significantly higher for patients who had surgical complications.
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