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Effect of Surprise Medical Billing in Elective Situations

A surprise medical bill is a bill from an out-of-network provider that was not expected by the patient or that came from an out-of-network provider not chosen by the patient. In a study, published in Health Affairs, researchers investigated consumers’ hospital choices after receipt of surprise out-of-network medical bills in an elective situation, using a large national sample of medical claims for obstetric patients with two deliveries covered by employer-sponsored health insurance in 2007–14. They found that 11 percent of mothers experienced a surprise out-of-network bill with their first delivery, and this was associated with an increase of 13 percent in the odds of switching hospitals for the second delivery, compared to mothers who did not experience a surprise bill. Mothers who switched hospitals after a surprise out-of-network bill reduced their relative risk of receiving a second surprise medical bill by 56 percent, compared to mothers who did not switch after receiving their first surprise bill. These results highlight the harmful effects of surprise out-of-network bills, as patients are more likely to switch from their preferred hospital after receiving a surprise bill. Patients would benefit significantly from laws protecting them from the damaging financial consequences of surprise out-of-network bills, including those incurred in elective situations.

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