logoThe 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?
Cc0 from https://pixabay.com/en/hospital-surgery-medical-health-721240/

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.

Rate this article
3.9- 42 ratings
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. .
Tired of the ads on our website?

Now you can browse our website completely ad-free for just $5 / month. Stay up to date on breaking health news and support our work without the distraction of advertisements.

Browse our website ad-free
  • 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
Join over 150,000 Subscribers at The People's Pharmacy

We're empowering you to make wise decisions about your own health, by providing you with essential health information about both medical and alternative treatment options.

Showing 7 comments
Add your comment

What are “health insurance exchange plans?”

A relative of mine works for a national health insurance company. She says they get these calls everyday from clients who thoroughly made sure their surgery was covered but still received a bill from someone not in their network. It almost always was from an anesthesiologist. To me it sounds like a bait and switch scam. Guess you must have it in writing that you’ll NOT pay for anyone not in your network.

Yes, following a surgery in which I had verified that the hospital, the surgeon, the anesthesiologist, the radiologist, and the pathologist were all in-network, I received an EOB showing some enormous out-of-network charge for the surgical assistant (someone no one had previously mentioned, and I had not thought of). Fortunately, when I called the practice of the surgical assistant, I was informed that they would accept the PPO allowed in-network benefits, and not bill for the difference. They said they would do this as a courtesy to the surgeon. Whew!

But this just goes to show that it is imperative to ask for a list of everyone and every facility involved in your procedure, so that you can check whether they are in-network with your insurance company.

I went to a first-rate nationally-known medical clinic with proof of my Medicare and supplemental insurance. But I received bills from the doctors who did not participate in Medicare. So I wrote 2 letters saying that, by federal law, if a hospital accepts Medicare and a supplement, the doctors working there must accept both insurances. But when I received the 3rd bill, I asked them to contact my attorney. Then I did not hear from them. Especially in a place like that, where the doctors are employed by the clinic, they cannot bill the patient when they have insurance. I am a retired physician and have some knowledge of billing practices.

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.

* Be nice, and don't over share. View comment policy^