We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Assessment of Out-of-Network Billing for Privately Insured Patients Receiving Care in In-Network Hospitals.
- Authors
Sun, Eric C.; Mello, Michelle M.; Moshfegh, Jasmin; Baker, Laurence C.
- Abstract
<bold>Importance: </bold>Although surprise medical bills are receiving considerable attention from lawmakers and the news media, to date there has been little systematic study of the incidence and financial consequences of out-of-network billing.<bold>Objective: </bold>To examine out-of-network billing among privately insured patients with an inpatient admission or emergency department (ED) visit at in-network hospitals.<bold>Design, Setting, and Participants: </bold>A retrospective analysis using data from the Clinformatics Data Mart database (Optum), which includes health insurance claims for individuals from all 50 US states receiving private health insurance from a large commercial insurer was conducted of all inpatient admissions (n = 5 457 981) and ED visits (n = 13 579 006) at in-network hospitals between January 1, 2010, and December 31, 2016. Data were collected and analyzed in March 2019.<bold>Exposures: </bold>Receipt of a bill for care from at least 1 out-of-network physician or medical transport service associated with patient admission or ED visit.<bold>Main Outcomes and Measures: </bold>The incidence of out-of-network billing and the potential amount of patients' financial liability associated with out-of-network bills from the admission or visit.<bold>Results: </bold>Of 5 457 981 inpatient admissions and 13 579 006 ED admissions between 2010 and 2016, the percentage of ED visits with an out-of-network bill increased from 32.3% to 42.8% (P < .001) during the study period, and the mean (SD) potential financial responsibility for these bills increased from $220 ($420) to $628 ($865) (P < .001; all dollar values in 2018 US$). Similarly, the percentage of inpatient admissions with an out-of-network bill increased from 26.3% to 42.0% (P < .001), and the mean (SD) potential financial responsibility increased from $804 ($2456) to $2040 ($4967) (P < .001).<bold>Conclusions and Relevance: </bold>Out-of-network billing appears to have become common for privately insured patients even when they seek treatment at in-network hospitals. The mean amounts billed appear to be sufficiently large that they may create financial strain for a substantial proportion of patients.
- Publication
JAMA Internal Medicine, 2019, Vol 179, Issue 11, p1543
- ISSN
2168-6106
- Publication type
journal article
- DOI
10.1001/jamainternmed.2019.3451