Out-of-network billing rises, leaving patients with surprise expenses

Out-of-network billing in emergency departments has risen over the last few years, often leaving patients with surprise expenses even when they have insurance coverage and receive care from an in-network hospital.

From 2010 to 2016, out-of-network billing has jumped from 32.2% of ED visits to nearly 43%, according to a study published in JAMA Internal Medicine. The percentage of inpatient admissions with an out-of-network bill also rose, from 26.3% to 42%.

Researchers from Stanford analyzed out-of-network billing among privately insured patients with an inpatient admission or ED visit between 2010 and 2016. They specifically looked at nearly 5.5 million inpatient admissions and 13.6 million ED admissions over that time period.

In addition to more out-of-network billing across the hospital visits measured, the potential financial responsibility of the bills from ED visits increased, from $220 to $628, according to the study, while the bills from inpatients admissions jumped from $804 to $2,040.

The issue of out-of-network billing has come into the limelight after sky-high medical bills have left patients with huge debts. The issue has also caught the attention of lawmakers as they consider protections for patients with private insurance. Hospitals are not allowed to practice balance billing, which seeks additional payments for out-of-network physicians from patients, for Medicare patients, but no such rules exist for privately insured patients. The outcome of surprise medical bills for patients can be detrimental.

“Even modest unexpected bills can create financial stress for patients,” first study author Eric C. Sun, MD, PhD, of the Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, et al. wrote.

Patients may not even have much of a choice when it comes to out-of-network billing, as it can happen often in emergency and transportation services when patients may not be in a position to choose their care and practitioners. Patients could be better protected by insurers picking up some of the financial responsibility in these circumstances.

“Policies that limit the ability of physicians and medical transport services to balance bill patients—for example, by shifting some portion of the patient’s responsibility to insurers—offer stronger protection,” Sun and colleagues wrote.

Further, the researchers noted that their study may have actually underestimated the extent of out-of-network billing, since their scope was limited to inpatient admissions and ED visits.