A study in JAMA Health Forum estimated the frequency and magnitude of surprise bills for deliveries and newborn hospitalizations, which are the leading reasons for hospitalization in the US. The study found among privately insured families with in-network deliveries in 2019, almost 1 in 5 potentially received surprise bills for maternal and/or newborn care. Surprise bills were more frequent and larger when cesarean delivery or neonatal intensive care occurred.
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.
Analyses included 95,384 families. Deliveries for these families were 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. Among these families, the median total liability for potential surprise bills was $744; for 6,417 families (35.8%), total liability exceeded $2000.
Researchers noted the high frequency of out-of-network care in their study, coupled with the fact that childbirth is the most common reason for hospitalization, suggests that childbirth hospitalizations are currently one of the most frequent sources of surprise bills in the US.
- Prevalence and Magnitude of Potential Surprise Bills for Childbirth. JAMA Health Forum. July 2 2021