Americans often receive bills from out-of-network providers following surgery, study finds. Photo by by
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Feb. 11 (UPI) -- One in five Americans who has surgery receives bills from out-of-network providers, even when they choose physicians from within their insurance networks, a new study has found.
An analysis published Tuesday by the Journal of the American Medical Association revealed that 20.5 percent of people undergoing procedures receive bills from providers who don't take their insurance, with "surgical assistants" and anesthesiologists being the most common sources of these charges.
And, these out-of-pocket and often unexpected expenses aren't insignificant, with fees in many cases approaching $4,000 -- if not more -- researchers say.
"Our paper makes it clear that, even for Americans with insurance, the healthcare system is simply not doing right by its patients," study co-author Karan R. Chhabra, of the University of Michigan Institute for Healthcare Policy and Innovation, told UPI. "Even for patients who do their homework, a substantial amount of them can get large and damaging out-of-network bills. It is unfair to expect patients to be able to navigate this complexity on their own. I think it ultimately falls on our lawmakers to solve this problem."
According to the National Center for Health Statistics, approximately 50 million in-patient -- surgical procedures -- those that require a hospital stay -- are performed annually in the United States. For their research, Chhabra and his colleagues analyzed claims data from a large, private insurer for nearly 350,000 people who had undergone a surgical procedure.
Their analysis focused on seven commonly performed operations: arthroscopic meniscal repair, laparoscopic cholecystectomy, hysterectomy, total knee replacement, breast lumpectomy, colectomy and coronary artery bypass graft surgery.
Among those who received surprise bills, 37 percent were billed by surgical assistants or anesthesiologists. The mean potential bills from surgical assistants totaled $3,633, while the same figure for anesthesiologists was $1,219.
The analysis also revealed that those covered by plans obtained through the Affordable Care Act health insurance exchange were more likely to be billed for out-of-network services than members of non-exchange plans, 27 percent versus 20 percent. In addition, procedures with complications were associated with a higher risk for out-of-network bills compared to those with no complications, 28 percent versus 20 percent.
Among 83,021 outpatient procedures -- surgery not requiring a hospital stay -- analyzed by the authors, 6.7 percent included an out-of-network facility bill and 17.2 percent included an out-of-network professional bill.
Chhabra says patients should check with their insurance company to make sure their doctors and hospital are covered, but offered further advice to limit the risk for surprise bills from out-of-network providers.
"Check with your doctor to see if they work with other doctors or assistants who might not take the same insurance," Chhabra said. "You can also ask if you should expect other clinicians to be involved in your care: for example, anesthesiologists, radiologists, pathologists or special outside laboratories. And check with your hospital to see if those other doctors accept your insurance."
