Privately insured patients are receiving surprise bills from in-network hospitals

Aug. 14, 2019
Healthcare costs have risen as much as 185 percent for an emergency department visit.

An analysis of claims data for privately insured patients suggests out-of-network billing for inpatient admissions and emergency department (ED) visits to in-network hospitals has increased along with the patient financial liability associated with it, reports the JAMA Network in a news release.

This study included 5.4 million inpatient admissions and nearly 13.6 million ED visits to in-network hospitals between 2010-2016. Of all the ED visits, 39.1 percent generated an out-of-network bill and 37 percent of all the inpatient admissions resulted in an out-of-network bill. 

The percentage of ED visits with an out-of-network bill increased from 32.3 percent to 42.8 percent during the study period and the percentage of inpatient admissions with an out-of-network bill increased from 26.3 percent to 42 percent during that same time. 

The potential patient financial responsibility associated with out-of-network bills increased too, from an average $220 to $628 for ED visits and from an average $804 to $2,040 for inpatient admissions. A common example of out-of-network billing was ambulance transport.

This study has some limitations, including no information on what patients actually paid to settle out-of-network bills. Researchers suggest their findings support strengthening legislative protections against the surprise medical bills associated with out-of-network billing.