Out-of-network billing costs at in-network hospital EDs more than doubled: study

hospital doctor with patient
Out-of-network billing on the rise for in-network admissions. (monkeybusinessimages/Getty Images)

It appears that out-of-network billing for inpatient admissions and emergency department (ED) visits is becoming more common and expensive for patients.

Publishing in JAMA Network, study researchers examined 5.4 million inpatient admissions and 13.6 million ED visits between 2010 and 2016 and found that more than 39% of ED visits generated an out-of-network bill and 37% of all inpatient admissions resulted in an out-of-network bill.

The analysis of the claims data for privately insured patient showed an increase from 32.3% to 42.8% of ED out-of-network bills during the time period.

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The study, led by Eric Sun, M.D., assistant professor in the Department of Anesthesiology, Pain and Perioperative Medicine at Stanford University, also found an increase from 26.3% to 42% of inpatient admissions with out-of-network bills.

RELATED: Two-thirds of ED visits avoidable: report

Overall, the changes resulted in an increase from around $220 to $628 for an average ED patient visit for those with private insurance and an average increase from $804 to $2,040 for inpatient admissions costs.

Out-of-network billing for ED visits was particularly common for ambulance transport: 85.6% of encounters with ambulance services resulted in an out-of-network bill, with a mean potential financial responsibility of $244 to the patient.

Of patients receiving care from an emergency physician, 32.6% received an out-of-network bill while 23.8% of patients received an out-of-network bill from care from an internist and 22.8% received an out-of-network bill from care from an anesthesiologist.

When it comes to inpatient admissions, physician specialties with the most frequent out-of-network billing ranged from 0.8% for obstetrics and gynecology to 81.6% for ambulance services.

In a subgroup analysis, the incidence of out-of-network billing was lower for surgical admissions (30.9% versus 42.0%), but the potential financial liabilities were higher (mean liability of $2,406 versus $914).

In 2016, patients with out-of-network bills faced a potential liability as high as $4,112 or more.

RELATED: Out-of-pocket costs increased across all healthcare in 2018

As of June, 25 states have enacted legislation offering some protection against out-of-network billing, ranging from dispute resolution processes to provisions holding the insurer responsible for the balance-billed amount.

In the U.S. Congress, pending legislation could help limit the scope and effects of out-of-network billing.

“Because out-of-network bills most commonly originated from clinical services (ie, medical transport, emergency medicine) about which patients have little choice, policy solutions centered on disclosure and consent at the point of care may not meaningfully address a large part of the problems patients face," the authors said in the report. "Policies that limit the ability of physicians and medical transport services to balance bill patients—for example, by shifting some portion of the patient’s responsibility to insurers—offer stronger protection."

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