Study: 4 in 10 patients faced surprise bills in 2016 after visiting in-network hospitals

September 4, 2019

Original article: Jessie Hellmann - The Hill

Four in 10 privately insured patients faced surprise medical bills after visiting emergency rooms or getting admitted to hospitals in 2016, according to a new study published Monday in the American Medical Association's internal medicine journal.

The average price tag for a surprise bill related to care at an emergency department was $628 in 2016, up from $220 in 2010, according to the study. The average surprise bill for inpatient admissions increased from $804 in 2010 to $2,040 in 2016.

The percentage of patients facing those bills also increased.

In 2016, 42.8 percent of emergency room visits resulted in surprise bills for patients, an increase of 10 percentage points from 2010. And 42 percent of inpatient admissions also resulted in surprise bills, a 16-point increase from 2010.

Patients can face surprise bills when they visit an emergency room covered by their insurance, but are treated by doctors who are not. Out-of-network doctors can bill patients for what insurance doesn’t cover, resulting in a surprise bill.

“Out-of-network billing appears to have become common for privately insured patients even when they seek treatment at in-network hospitals,” the researchers concluded.

The bills may create “financial strain for a substantial proportion of patients.”

Ambulance rides were the biggest source of out-of-network bills, according to the study, which analyzed 14 million emergency department admissions and 5 million inpatient admissions between 2010 and 2016.

Nearly 86 percent of patients faced surprise bills after taking an ambulance to the emergency room, owing an average of $244.

Congress is working to crack down on the issue, with the Senate potentially voting soon on a bill that aims to protect patients from getting massive surprise medical bills. But ambulances are not included in that legislation because those services are typically run by local and municipal governments.

Twenty-five states have enacted similar legislation protecting patients from out-of-network billing when they seek services at in-network facilities.

Surprise billing has received considerable media attention over the past year, from a $50,000 allergy test to a $500,000 dialysis bill.