A new study published in JAMA found that among privately insured families with in-network deliveries in 2019, almost 1 in 5 potentially received surprise bills for maternal and/or newborn care.
In 2022, federal legislation will protect families from most surprise bills which are defined as charges for out-of-network-care at in-network facilities. This study sought to illustrate the potential benefits of this legislation by estimating the frequency and magnitude of surprise bills for deliveries and newborn hospitalizations, which are the leading reasons for hospitalization in the US.
Researchers analyzed 2019 data from Optum’s deidentified Clinformatics Data Mart, which includes 12 million privately insured enrollees in all states. Analyses included families with an in-network delivery in 2019 that could be linked to 1 or more in-network newborn hospitalization that was covered by the same family plan. Potential surprise bills were defined as professional claims from out-of-network clinicians and ancillary service providers (eg, ambulance providers).
Analyses included 95,384 families with deliveries for these families linked to 96,881 newborn hospitalizations. Of all families, 17,949 (18.8%) had 1 or more potential surprise bill for the delivery, newborn hospitalization(s), or both. For these families, estimated liability for potential surprise bills averaged $744, an amount larger than the estimated liability for colonoscopy but smaller than that for surgical care. For one-third of families that received potential surprise bills, the estimated liability exceeded $2000. Surprise bills were more frequent and larger when cesarean delivery or neonatal intensive care occurred.
- Prevalence and Magnitude of Potential Surprise Bills for Childbirth. JAMA. July 2, 2021