The highest percentage ofspecialty surprise claims came from anesthesiology, at 16 percent.Primary care represented 13 percent, and emergency medicine 11percent. (Photo: Shutterstock)

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A new study finds that one in seven patients are hit with asurprise medical bill—an out-of-network chargefor a medical service—even though they were admitted to anin-network hospital.

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The new analysis, from the Health Care CostInstitute (HCCI), looked at 620,000 patients across 37 states andthe District of Columbia in 2016. “Overall, we found that 14.5percent of these admissions had at least one associatedout-of-network professional claim; that is, roughly 1 in 7 patientsreceived a surprise bill despite obtaining care at an in-networkhospital,” the report said.

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Related: Majority of people have received unexpected medicalbills in the past year

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The issue has raised confusion and controversy as patients whoare treated at a hospital that is part of their insurance networkreceive bills for services provided by out-of-network practitionersor facilities. At a time when consumer engagement is promoted byhealth care providers and payers, these unexpected bills underscorehow much of the health care delivery system is still nottransparent.

Geographic area makes a difference

The report noted that there was a wide range to theout-of-network charges, depending on the state. “In Florida, 26.3percentage of the sample's in-network admissions had an associatedsurprise bill––the largest percentage of any state in the study,”the report said. “This was over 15 times greater than in Minnesota(1.7 percent of admissions), the state with the lowestprevalence.”

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The study found 19 states that had between 10 and 19 percent ofin-network admissions with services provided by out-of-networkprofessionals. Six states had out-of-network claims with between 20percent and 26 percent of inpatient hospital admissions.

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One of the analysts, Kevin Kennedy, told Modern Healthcare that the numbers werestriking, but the state-by-state comparisons could lead tosolutions. “By showing state-by-state variation, maybe we can seewhat Minnesota is doing with the relationships between hospital andinsurers and the legislation involved and how it compares to stateslike Florida or Kansas,” he said.

Breaking down claims by specialty, frequency

The study also looked at which specialties had the largest shareof out-of-network claims for in-network hospital admissions as awhole. It also looked at what percentage of claims from individualspecialties fell under the surprise category.

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The highest percentage of specialty surprise claims came fromanesthesiology, at 16 percent. That was followed by an “otherphysician” category (14 percent), primary care (13 percent), andemergency medicine (11 percent).

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Independent labs had the highest rates of claims that fell intothe in-network admission/out-of-network claim category, at 22percent of their total claims, followed by emergency medicine at 12percent. Most other specialties were under 10 percent in thisarea.

Surprise billing brings lawsuits, legislative proposals

The surprise billing issue has resulted in a number of lawsuits,and the issue has prompted legislative proposals on both the stateand federal level.

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There have been bipartisan bills introduced in Congress toaddress the issue in various ways, and the Trump Administration hasvowed to fix the problem, according to National Public Radio.

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“President Trump has identified surprise medical bills as aserious concern of the administration. Protecting patients fromthese outrageous and unexpected bills and charges is a top priorityfor Secretary [Alex] Azar,” Caitlin Oakley, a Department of Healthand Human Services spokeswoman, said recently.

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