1 in 5 Patients Receive Surprise Bills After Elective Surgery

By Morgan Haefner, Becker’s Hospital Report, Feb.12, 2020.

Studies have shown 1 in every 6 emergency room visits and inpatient hospital stays for patients with health insurance through their employer led to at least one out-of-network medical bill in 2017. Researchers from the University of Michigan in Ann Arbor, Brigham and Women’s Hospital in Boston and Harvard Medical School in Boston found surprise medical bills are likely just as common in elective services as in the ER. While often framed as an emergency room issue, patients undergoing elective surgery aren’t immune from surprise out-of-network bills, according to a study published in JAMA.

For elective services like knee surgery and hysterectomy, patients with employer-based coverage may ensure their surgeons and hospital are in network. However, patients can receive out-of-network bills from clinicians who aren’t their choice, like anesthesiologists and surgical assistants.

For their study, the researchers completed a retrospective analysis of nearly 350,000 surgical episodes based on claims from a large national payer. The episodes were among commercially insured patients who underwent an elective surgery with an in-network surgeon and facility between 2012-17.

The researchers found of the episodes studied, 20.5 percent, or 1 in 5, involved out-of-network charges. Anesthesiologists and surgical assistants were each associated with 37% of surprise bills.

The mean potential balance bill per episode was $2,011.

“In this retrospective analysis of commercially insured patients who had undergone elective surgery at in-network facilities with in-network primary surgeons, a substantial proportion of operations were associated with out-of-network bills,” the authors concluded.