No matter how a patient's healthplan responds to an out-of-network bill, the result is higher costsfor consumers. (Photo: Shutterstock)

Patients would save billions of dollars a year if medicalspecialists were not allowed to bill out-of-network rates.

An analysis of 2015 data obtained from a "largecommercial insurer" showed that a significant percentage of medicalservices were billed out-of-network, including 11.8 percent ofanesthesiology care, 12.3 percent for care involving a pathologist,5.6 percent of claims for radiologists, and 11.3 percent of casesinvolving an assistant surgeon.

According to the research, reported earlier this week in HealthAffairs, if out-of-network billing were eliminated, overallpayments to doctors would decrease by 13.4 percent and patientspending on health care would drop 3.4 percent, or by roughly $40billion annually.

Related: Surprise out-of-network medical bills outlawed inNew Jersey

Out-of-network billing is more common in markets where there arefewer hospital and insurance options. It was also significantlymore frequent at for-profit hospitals. "For-profit hospitals havean incentive to take a share of the profits earned from physicians'surprise billing," wrote the study authors.

Out-of-network billing was least likely to occur at teachinghospitals.

No matter how a patient's health plan responds to anout-of-network bill, the result is higher costs for consumers, thestudy notes. While outrage has focused on cases where the insurerdeclines to cover the bill and leaves the patient with a hugeout-of-pocket expense, the higher cost of out-of-network billing ispassed onto consumers through higher premiums even when insurersopt to cover the claim.

Moreover, physicians can leverage their ability to billout-of-network in order to negotiate higher in-networkpayments.

The study proposes regulations to protect patients from surprisebill. While a number of states have put in place laws that holdspatients harmless in the event that they receive unavoidabletreatment at an out-of-network hospital, there are not yet robustregulations dealing with out-of-network specialists at in-networkproviders.

One option that has been floated is to set a standard rate forout-of-network billing. The potential problem with this approach,however, is that if the rate is set too low, insurers would perhapsforgo setting up networks since they could rely on theout-of-network rate. In an "extreme" instance, low reimbursementrates might prompt doctor shortages.

Other options include requiring arbitration between physiciansand insurers and requiring doctors to participate in the samenetworks as the hospitals they work in.

The option the study authors favor, however, is for hospitals to"sell a bundled package of services" that includes the prices forvarious physician consultations. The hospital would set the pricesand then hire doctors to perform the services.

"Under this bundled care approach," wrote the study authors,"physicians would compete to offer their services on the basis ofprice and quality. Hospitals would compete with one another on theprice and quality of their care, including the services provided bythe physicians they recruited. Hospitals would also need to competeto retain physicians."

Read more: 

• Are carriers and PPO networks slowly becomingobsolete?
• 10 states with the least competitive healthinsurance markets
• Balance-billing court cases force hospitals tojustify charges