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Study Finds 20% of Patients Experience Out-of-Network Billing After Elective Surgery

A new study, published in JAMA Network, sought to establish how often are patients undergoing elective surgery with in-network primary surgeons at in-network facilities at risk for receiving out-of-network bills. An analysis of 347,356 surgical episodes among commercially insured patients who had undergone elective surgery with in-network primary surgeons and facilities, found 20% of episodes involved out-of-network charges. Researchers concluded patients undergoing elective surgery with in-network primary surgeons and facilities may be at risk of receiving out-of-network bills.

The study involved analysis of claims data from a large US commercial insurer, representing 347,356 patients who had undergone 1 of 7 common elective operations (arthroscopic meniscal repair; laparoscopic cholecystectomy; hysterectomy; total knee replacement; breast lumpectomy; colectomy; coronary artery bypass graft surgery by an in-network primary surgeon at an in-network facility between January 1, 2012, and September 30, 2017.

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One Comment

  1. Martina Dolan Post author | February 12, 2020

    More on this topic:

    Fierce Healthcare: 1 in 5 patients get surprise bill after elective surgery. How costly was it? – https://www.fiercehealthcare.com/practices/1-5-patients-get-surprise-bill-after-elective-surgery-study-finds-how-costly-was-it

    Modern Healthcare: Study finds 1 in 5 patients gets surprise bills for elective surgeries- https://www.modernhealthcare.com/payment/study-finds-1-5-patients-gets-surprise-bills-elective-surgeries

    Healthcare Dive: 1 in 5 surgery patients hit with surprise medical bill, JAMA study finds – https://www.healthcaredive.com/news/1-in-5-surgery-patients-hit-with-surprise-medical-bill-jama-study-finds/572099/

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