Nonetheless, one in eight claims included off-network charges. This corresponds to approximately 136,000 colonoscopys in which a patient may receive a surprising bill. (There was no way to determine how many patients actually went, Scheiman said.)
These off-network charges typically cost around $ 1,000. Considering the portion that insurance companies are likely to pay, researchers estimated that a typical surprise invoice would be about $ 400.
Overall, the researchers found that anesthesiologists and pathologists (doctors studying tissue samples) accounted for the majority of off-network fees.
And that’s not surprising, said Lauren Adler, associate director of the USC-Brookings Schaefer Health Policy Initiative in Washington, DC.
In general, according to Adler, surprise invoices come from a limited number of disciplines and are the provider of choice for patients. Emergency room doctors, anesthesiologists, radiologists, pathologists, and ambulance services are the main sources of information.
“In my eyes, this is due to market failure,” Adler said. For example, primary care physicians and surgeons have great incentives to join the health insurance network and attract patients covered by their insurance.
However, in certain disciplines, hospitals or other workplaces determine the number of patients a healthcare provider sees. These doctors can stay off the network, charge the required amount, collect some amount from the insurance company, and charge the patient the remaining amount.
This practice clearly has an economic impact on the patient. But it also costs people with private health insurance, Adler said. The plan raises monthly premiums to cover the costs of off-network providers.
This is because health insurance may pay full off-network charges. He said it was also because those same experts ordered higher in-network prices compared to other disciplines.
According to Adler, many hospitals have moved to address this issue and doctors need to join the center’s insurance network.
He added that a wide range of solutions would be laws that limit off-network charges. Some states have passed legislation that protects patients, at least in part, from surprise bills, but federal action is at a standstill.