Nearly 1 in 12 colonoscopies without an associated intervention ended with an out-of-network claim, according to a new study published in the Annals of Internal Medicine.
Medpage Today reported on the study, which examined claims data from 118,769 elective colonoscopies that were performed with in-network endoscopists and facilities. Researchers found that 12.1 percent of those procedures had an associated out-of-network claim.
Median rates for the surprise claims were $418, with the majority of claims resulting from out-of-network anesthesiologists (64 percent of cases). Pathologists accounted for the second most surprise claims (40 percent of cases).
Out-of-network claims were more likely to occur in cases with an intervention.
In cases with visual inspection only, anesthesiologists accounted for an out-of-network claim 95 percent of the time.
Surprise medical bills related to colonoscopies are illegal because the ACA eliminated consumer cost sharing for colonoscopy, according to the report. Karen Joynt Maddox, MD, of Washington University School of Medicine in St. Louis, said to Medpage that the study was concerning because colonoscopies should be covered without cost sharing.
"Ultimately the people losing are the patients, so we need to find a path forward to end surprise billing," Dr. Joynt Maddox said.
Note: Dr. Joynt Maddox is not affiliated with the study.
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