The problem of large and unexpected surprise healthcare bills dominated health headlines in 2019.
Now, a new study to be published in the January print issue of Health Affairs put a figure on how much it's costing when patients are unwittingly treated by out-of-network providers in in-network hospitals: $40 billion annually.
Led by Zack Cooper, a researcher in the Yale School of Public Health and the department of economics, the study found at in-network hospitals, nearly 12% of anesthesiology care, more than 12% of care involving a pathologist, 5.6% of claims for radiologists and 11.3% of cases involving an assistant surgeon were billed out of network.
RELATED: Out-of-network billing costs at in-network hospital EDs more than doubled: study
The researchers’ estimates show that if these specialists were not able to bill out of network, it would lower physician payments for privately insured patients by 13.4% and reduce total healthcare spending for people with employer-sponsored insurance by 3.4%. That works out to about $40 billion a year, they said.
The authors used 2015 data from a large commercial insurer for their analysis. The study was funded by the Laura and John Arnold Foundation and the Tobin Center for Economic Policy at Yale University.
Out-of-network billing is more prevalent at hospitals in concentrated hospital and insurance markets and at for-profit hospitals, the authors said.
“Any policy addressing out-of-network billing must achieve two aims: protect patients from financial harm and introduce a competitively set price for physician services or identify the amount insurers must pay providers if a policyholder is treated by an out-of-network physician,” the authors said in a statement. “Our proposed policy solution—requiring hospitals to sell a package of facility and physician services—would protect patients, restore a competitively determined price for physician services, and lower commercial health spending.”