If you are having an elective surgical procedure, don’t be suprised if you get a higher-than-expected bill—even if you have the procedure done by an in-network surgeon at an in-network facility.
A study published in JAMA in February 2019 looked at insurance claims data from more than 347,000 people who underwent one of seven common elective (as opposed to emergency) operations between 2012 and 2017: arthroscopic meniscal repair (a type of knee surgery), laparoscopic cholecystectomy (removal of the gallbladder), hysterectomy, total knee replacement, breast lumpectomy, colectomy (removal of part of the colon), or coronary artery bypass graft surgery.
Although all of the individuals chose a surgeon and a hospital within the network of their large private insurance plan, one in five were later hit with a bill for the services of an out-of-network clinician who participated in their surgery. Anesthesiologists and surgical assistants were the most commonly listed out-of-network providers on such bills, which had an average balance of $2,011; others included radiologist, pathologists, and “medical consultants.”
People with insurance purchased through the health exchange were more likely than people with employer-sponsored plans to receive a surprise bill. The fact that patients usually have no knowledge that such bills might occur and no way to avoid them makes the practice “particularly pernicious,” two JAMA editors wrote in an accompanying editorial. Some states have enacted policies to protect patients from out-of-network bills from in-network facilities, but it’s unclear how effective these policies have been.
Also see What to Do About a Surprise Medical Bill.