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.
- Out-of-Network Bills for Privately Insured Patients Undergoing Elective Surgery With In-Network Primary Surgeons and Facilities. JAMA Network. February 11 2020.