Out of about 350,000 surgeries for patients covered by a nationwide commercial insurer, researchers found 20% received bills for services their insurance didn’t pay for, according to a study published Thursday in the Journal of the American Medical Association (JAMA,) a peer-reviewed medical periodical.
The average unexpected charge of about $2,000 can especially hurt vulnerable populations, such as people with more health issues or who had complications after operations, said Dr. Karan Chhabra, the lead author of the University of Michigan study.
“Even if patients do their homework before they have elective surgery, this study shows they can be at risk of receiving large bills they never expected, from providers they never met or even knew about,” Chhabra said in a press release.
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Despite going to hospitals and primary doctors who accept their health insurance, the analysis found patients owed money to other medical staff involved in the surgery or after care. Anesthesiologists or surgical assistants might have been out of their insurance network, for example, prompting providers to bill patients directly.
The finding of 20% receiving surprise medical bills for elective surgeries is twice as high as similar studies, said Erin Duffy, a research fellow at University of Southern California’s Center for Health Policy and Economics. She’s also an adjunct policy researcher at RAND, a nonprofit institution that aims to improve policy and decision-making through data analysis.
By doing calculations with an average allowed amount instead of what was permitted in the specific case, researchers estimated a greater prevalence of surprise billing, said Duffy, who was not involved in the study. The one insurer studied might not be representative of other providers either, she said.
Unexpected medical bills for emergency care and optional procedures alike have prompted nine states to pass laws preventing surprise billing, according to the National Conference of State Legislatures, but they have their limits.
“A major limitation of existing state regulations to address surprise billing is that they only apply to fully-insured health plans,” Duffy said. “In most states, that’s about half of the commercial insurance market. The rest of the plans that are self-insured are regulated by the federal government.”
President Donald Trump called on Congress to curb unexpected medical charges last summer and three bills have been proposed in the House and Senate so far.
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Calls for more transparency in health care pricing have increased as the average cost of hospital emergency room visits have surged 176% between 2008 and 2017, according to the Health Care Cost Institute.
The average health insurance plan has also risen between 2006 and 2017, from $4,242 to $6,690 for an individual and $11,480 to $18,764 for a family. The average person with employer-sponsored health coverage also saw a nearly five-fold increase in deductibles, from $303 to $1,505.
If patients receive a surprise bill, the study authors recommend filing complaints with state insurance regulators, asking for discounts of their share of the bill and requesting the insurance company pay the unexpected charge.
Contributing: Ken Alltucker, USA TODAY