Are hospitals stacking the deck against patients? People with insurance have learned that they need to ask whether the surgeon as well as the hospital are in-network before elective surgery. Despite doing so, some get stuck with unexpected bills.
The Story on Unexpected Bills:
A new study suggests that unexpected bills from surgery are relatively common (JAMA, Feb. 11, 2020). The investigators studied nearly 350,000 surgeries. These patients were undergoing elective procedures with an in-network surgeon in an approved facility. Yet even when patients asked all the right questions, nearly one in five was left with some out-of-network bills. As a result, they had to pay, on average, more than $2,000 out of pocket.
Where did the out-of-network charges on these unexpected bills come from? Frequently, they were associated with surgical assistants and anesthesiologists. If these health professionals were out of network, they frequently billed more than the in-network staffers. Moreover, the investigators note that health insurance exchange plans were more likely to generate such unexpected bills.
What Can You Do?
It pays to ask in advance whether there could be any out-of-network charges. You might be able to ask the hospital to cap such charges at a more affordable rate. You can learn more about avoiding such fees from our interview with Dr. Elisabeth Rosenthal. It is Show 1114: How Health Care Became Big Business.