The People's Perspective on Medicine

Unexpected Bills Come as Nasty Postsurgical Surprise

Around 20 percent of insured patients were faced with unexpected bills after surgery that should have been in-network. What's going on?
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Are hospitals stacking the deck against patients? People with insurance have learned that they need to ask whether the surgeon as well as the hospital are in-network before elective surgery. Despite doing so, some get stuck with unexpected bills.

The Story on Unexpected Bills:

A new study suggests that unexpected bills from surgery are relatively common (JAMA, Feb. 11, 2020). The investigators studied nearly 350,000 surgeries. These patients were undergoing elective procedures with an in-network surgeon in an approved facility. Yet even when patients asked all the right questions, nearly one in five was left with some out-of-network bills. As a result, they had to pay, on average, more than $2,000 out of pocket.

Where did the out-of-network charges on these unexpected bills come from? Frequently, they were associated with surgical assistants and anesthesiologists. If these health professionals were out of network, they frequently billed more than the in-network staffers. Moreover, the investigators note that health insurance exchange plans were more likely to generate such unexpected bills.

What Can You Do?

It pays to ask in advance whether there could be any out-of-network charges. You might be able to ask the hospital to cap such charges at a more affordable rate. You can learn more about avoiding such fees from our interview with Dr. Elisabeth Rosenthal. It is Show 1114: How Health Care Became Big Business.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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  • Chhabra KR et al, "Out-of-network bills for privately insured patients undergoing elective surgery with in-network primary surgeons and facilities." JAMA, Feb. 11, 2020. doi:10.1001/jama.2019.21463
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Readers should not forget that they can contest the insurance settlements. Years ago I had minor surgery. I had gotten preauthorization and checked that the hospital and surgeon were in-network. I got a substantial surprise bill from the anesthesiologist. I called the insurance folks and asked how I was supposed to have checked that. Their response was “Okay, we’ll pay it.”

All it took was one quick phone call.

Healthcare in America sounds much like the Mafia.

If the hospital that does your procedure takes your insurance then everyone working there should too. This is ridiculous that in the United States this goes on. And politicians of both parties do nothing.

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