Nearly 1 in 8 commercially insured patients nationwide who underwent an elective colonoscopy between 2012 and 2017 performed by an in-network provider received potential “surprise” bills for out-of-network expenses, often totaling hundreds of dollars or more, according to a research report published in Annals of Internal Medicine.
Colonoscopy is the most effective colorectal cancer prevention strategy. However, researchers suggest that surprise billing may deter patients from getting recommended screening.
Researchers from the University of Virginia and the University of Michigan reviewed 1.1 million claims from a large national insurer to estimate the prevalence, amount, and source of out-of-network claims for commercially insured patients having an elective colonoscopy when all of the endoscopists and facilities were in-network. The researchers found that 12.1 percent of cases received out-of-network claims, with an average surprise bill of $418. The bills often came because of the use of out-of-network anesthesiologists and out-of-network pathologists.
- Surprise Billing for Colonoscopy: The Scope of the Problem. Annals of Internal Medicine. 13 October 2020