About 1 out of every 5 elective procedures leads to a patient receiving a surprise medical bill, and radiologists are playing a key role in these monetary sneak attacks.
University of Michigan researchers recently made this discovery in a new analysis of commercial claims data, highlighted Tuesday in JAMA. Analyzing nearly 350,000 surgical episodes, the team estimated that about 20% resulted in out-of-network charges, at an average cost to the patient of about $2,000.
About 22% of surgeries included a claim from an out-of-network radiologist, researchers noted, adding an average of about $284 to a balance. Surgical assistants were the biggest offenders, the analysis found, tallying a 37% rate and average balance of $3,633. Complications during surgery were “significantly” associated with such extra charges from imaging experts and other clinicians, they added.
“These are eye-popping numbers, which most clinicians are likely unaware of, and which patients can’t prepare for,” Karan Chhabra, MD, the study’s lead author and a national clinician scholar at the U-M Institute for Healthcare Policy and Innovation, said in a statement.
The $2,000 average tally was on top of the almost $1,800 that the patient would already owe, after insurance covered most of the cost. All patients in the study had specifically chosen an in-network surgeon who accepted their insurance to perform one of seven common, nonurgent procedures.
Experts noted that surprise bills in the study added up to anywhere from $86 for a medical imaging specialist aiding with a hysterectomy, up to $8,000 for a surgical assistant during a breast lumpectomy. To reach their final tallies, Chhabra and colleagues determined out-of-network charges billed to the payer for each surgery, and then deducted what the insurer typically paid for that procedure.
For radiologists and surgeons, the takeaway is that providers need to be more cognizant of what’s going to end up on their final bill. This is especially crucial in this era of increased scrutiny and consumer-directed care, with patients purchasing narrow-network plans that are cheaper, but limit their choices.
“Even if patients do their homework before they have elective surgery, this study shows they can be at risk of receiving large bills they never expected, from providers they never met or even knew about,” Chhabra said. “This disproportionately affects vulnerable populations, such as those who have weaker insurance coverage, and those with more health issues. For them, a surprise bill is adding insult to injury,” he added later.
This study will likely only add further fuel to the fire as U.S. lawmakers consider legislation to address surprise billing, while also investigating specific providers’ business practices.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.