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HCCI Analysis of Surprise Out-of-Network Medical Bills During In-Network Hospital Admissions

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A recent analysis of Health Care Cost Institute’s (HCCI) vast commercial claims database sought to explore the prevalence of these surprise bills associated with in-network hospital admissions across states and medical specialties. An examination of nearly 620,000 in-network inpatient admissions and all associated professional claims (both in- and out-of-network claims filed by the physician or other health care professional who rendered the service) across 37 states and the District of Columbia in 2016, found:

  • The share of in-network hospital admissions with at least one associated out-of-network professional claim ranged from 1.7% in Minnesota to 26.3% in Florida;
  • Anesthesiology accounted for the largest share (16.5%) of out-of-network professional claims associated with an in-network admission;
  • Among the specialty categories studied, independent labs most often billed out-of-network as part of an in-network hospital admission (22.1% of the time).

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