Out-of-network billing has significantly increased for patients with private health insurance receiving care at in-network hospitals, according to study results published in JAMA Internal Medicine.
In a retrospective analysis, researchers used data from the Clinformatics Data Mart database to evaluate the incidence of out-of-network billing among privately insured individuals with inpatient admissions or emergency department (ED) visits at in-network hospitals.
A total of 5,457,981 inpatient admissions and 13,579,006 ED visit health insurance claims from 2010 to 2016 were included for patients with private health insurance from large commercial insurers. The main outcomes were incidence of out-of-network billing and possible patient financial liabilities due to out-of-network billing from hospital admissions or visits.
From 2010 to 2016, the number of ED visits that included out-of-network bills increased from 32.3% to 42.8%; the average potential financial responsibility for these bills rose from $220 to $628. Inpatient admission trends for out-of-network bills increased similarly for the same timeframe from 26.3% to 42.0%; the average potential financial responsibility increased from $804 to $2040.
“From a policy perspective, a potential benefit of balance billing is that patients have flexibility to choose to receive care from out-of-network physicians,” the authors of the study noted. “However, inherent to this benefit is patients’ awareness that balance billing may occur and their willingness to pay the additional amount.”
“Our findings are notable because out-of-network billing was common among medical transport services and hospital-based physicians (eg, emergency physicians, radiologists, and anesthesiologists) providing care at in-network hospitals,” continued the investigators. “In such circumstances, patients could easily assume that the entire hospital team is in network and thus the balance billing may come as a surprise.”
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Sun EC, Mello MM, Moshfegh J, Baker LC. Assessment of out-of-network billing for privately insured patients receiving care in in-network hospitals [published online August 12, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.3451