'Surprise' out-of-network bills after in-network elective surgery

Bottom Line: Claims data from a large health insurer were used to examine how often patients unexpectedly receive out-of-network bills after having in-network elective surgery. These "surprise bills" typically occur when a patient receives care from a clinician, such as an anesthesiologist or surgical assistant, who doesn't participate in that patient's insurance network. This analysis included nearly 350,000 commercially insured patients who underwent elective surgery at in-network facilities with in-network primary surgeons between 2012 and 2017. The authors report that approximately 1 in 5 of these procedures resulted in an out-of-network bill, with an average potential balance of $2,011. Out-of-network bills were associated with anesthesiologists and surgical assistants in 37% of these surgeries. A limitation of the study is that claims data came from only one insurer.

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Authors: Karan R. Chhabra, M.D., M.Sc., University of Michigan, Ann Arbor, and coauthors.

(doi:10.1001/jama.2019.21463)

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JAMA