Study Finds Practice of Surprise Billing Rising for Emergency and Inpatient Visits

October 31, 2019

When it rains, it pours. While Americans are forced to accept the reality of escalating drug costs—some by as much as 909%—a new study published by The Journal of the American Medical Association (JAMA) found that the frequency of surprise billing is also on the rise.

As a refresher, a surprise bill is the charge a patient receives from an out-of-network provider working within an in-network hospital. Surprise billing, also known as balance billing, usually happens without the patient’s awareness or acceptance. Here in North Carolina, some estimates have pegged surprise bills to occur in about half of all trips to the Emergency Room.

Conducted by Stanford University researchers, the study in JAMA’s Internal Medicine publication reviewed 5.5 million inpatient admissions and 13.6 million emergency department visits across all 50 states. The patients in the cases were all privately insured, with their visits taking place between 2010 and 2016.

Researchers discovered that the percentage of emergency visits leading to a surprise bill climbed significantly from 2010’s rate of 32.3% up to the 42.8% noted in 2016. Similarly, the percentage of inpatient admissions soared from 26.3% to 42% during the same window.

In a move reflective of the entire industry’s continued tugging on patients’ wallets, the total cost of the bill for both categories nearly doubled across that time span. To put that into some real-life context, the top 10% of inpatient visits resulted in a bill exceeding $1,000—while the same segment of inpatient visits had costs totaling more than $3,000. 

As it turns out, ambulances were a consistent element in both the inpatient and emergency patients in the study. In cases where one visited for an emergency, more than 85% of those who needed an ambulance received an out-of-network bill. On the inpatient side, patients with ambulance encounters picked up a surprise bill more than 81% of the time.

One important point to mention is that the researchers couldn’t differentiate between which out-of-network bills the patient expected versus those they didn’t. However, it’s logical to assume that any patient visiting what they know to be an in-network facility would expect to receive treatment from in-network providers.

In a quote from the report featured in Modern Healthcare’s coverage, researchers said: "Our findings are notable because out-of-network billing was common among medical transport services and hospital-based physicians … providing care at in-network hospitals. In such circumstances, patients could easily assume that the entire hospital team is in-network and thus the balance billing may come as a surprise."

The Coalition has been outspoken against the practice of surprise billing for years. We’ve heard from countless North Carolinians who have fallen victim to this tactic, and we have written horror stories about collection agencies putting liens on patients’ homes because of unpaid charges and ambulances sticking patients with outrageously high bills. 

Fortunately, we’re not the only ones who have taken note. Lawmakers on both sides of the political spectrum have taken a keen interest in finding ways to end surprise billing. As recently as this summer, President Trump unveiled his ideas and called on Congress to help make that happen. 

Have the sky-high costs of healthcare in our state impacted you and/or your family’s lives? Do you want to do something about it? Join the Coalition now to receive updates about new legislation and policies that will affect YOUR healthcare. ​Sign up now!

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Action Needed

Let's stop Surprise Medical Bills together

1 in 6 patients get surprise medical bills!

This happens even to people who have insurance. 

This practice is unfair, immoral and damaging to our economy. It is also responsible for for raising our premiums in North Carolina by millions of dollars a year. 

Sign up to find out what you can do to stop surprise medical bills. 

 

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