Surprise medical bills getting bigger and more frequent

EVIDENCE CONTINUES to mount that patients are being hit with higher costs from surprise medical bills.

The latest indicator: A study in last week’s JAMA Internal Medicine revealed that surprise out-of-network bills and related costs are increasing for inpatient admissions and emergency department visits to in-network hospitals. It comes as congressional leaders are trying to craft a set of legislative fixes.

Stanford University researchers found that from 2010 through 2016, 39% of 13.6 million trips to the ED at an in-network hospital by privately insured patients resulted in an out-of-network bill. That figure increased during the study period from about a third of ED visits nationwide in 2010 to 42.8% in 2016.

Out-of-network billing among admissions to in-network hospitals occurred only slightly less often. Out of 5.5 million admissions, 37% resulted in at least one out-of-network bill during the entire seven-year period. The frequency rose from 26.3% in 2010 to 42% in 2016, according to the study.

Hospital and physician groups have lobbied to thwart federal legislation that would cap out-of-network pay. Congress hopes to pass legislation addressing surprise billing in September.

Researchers analyzed data from a single private health insurer. They found the cost to the patient associated with the surprise bills increased significantly during the study period. The patient’s potential financial responsibility from out-of-network ED bills grew from an average $220 in 2010 to $628 in 2016, though many patients’ bills far exceeded those averages. Those figures represent the difference between the amount charged by outof-network physicians or ambulances, and the amount the insurer would pay in-network for that service.

The potential cost to patients for outof-network bills from inpatient admissions grew from an average $804 in 2010 to $2,040 in 2016. In 2016, however, the 90th percentile of patients with out-of-network bills faced potential costs of $4,112 or more.

Ambulances accounted for the most out-of-network bills for both ED visits and inpatient admissions. For ED patients, 85.6% of ambulance encounters resulted in an out-of-network bill, while 81.6% of ambulance encounters for patients who were admitted resulted in a surprise bill. In both settings, emergency medicine and internal medicine were among the specialties that billed out-of-network most frequently. ●