Bills from out of network doctors rising in network hospitals
A growing number of Americans treated at hospitals that are part of their insurance networks are getting billed for out-of-network care, a U.S. study suggests.
The proportion of emergency room visits to in-network hospitals that result in out-of-network bills surged from 32.3% to 42.8% from 2010 to 2016, the study found. Over the same period, the proportion of inpatient hospital admissions to in-network hospitals that result in out-of-network bill surged from 26.3% to 42%.
Patients’ tabs for these out-of-network bills has climbed too, from an average of $220 to $628 for ER visits and from an average of $804 to $2,040 for inpatient hospital admissions.
“Out-of-network billing in both the inpatient and emergency room settings is common and has become more common over time,” said Dr. Eric Sun, lead author of the study and a researcher at Stanford University Medical Center in California.
“The amount of money involved can be a significant burden for many patients,” Sun said by email. “Even if they receive care at an in-network hospital, they may still face out-of-network bills.”
In the U.S., physicians in an insurer’s network have agreed to accept a set amount from the insurer as payment in full for their services. Out-of-network physicians, however, are not constrained by any in-network agreements and can seek additional payment from patients, a practice known as out-of-network balance billing.