Out-of-network billing increased sharply between 2010 and 2016, according to a new study released by JAMA Internal Medicine.

In an analysis of 13.5 million emergency department admissions, researchers at Stanford found that patients were billed for services outside of their insurance network 42.8 percent of the time in 2016, up from only 32.3 percent six years earlier.

Out-of-network bills are nearly as common for inpatient admissions. Forty-two percent of the 5.5 million inpatient services the researchers examined were out-of-network, up from only 26 percent in 2010.

While it’s impossible to know exactly what each patient paid, the study noted that the average potential cost of each out-of-network admission nearly tripled for ER visits, from $220 to $628. For inpatient admissions, it more than doubled, from $804 to $2,040.

“Out-of-network billing appears to have become common for privately insured patients even when they seek treatment at in-network hospitals,” wrote Eric C. Sun and Michelle M. Mello. “The mean amounts billed appear to be sufficiently large that they may create financial strain for a substantial proportion of patients.”

Lawmakers and patient advocacy groups have been pushing for legal changes to reduce “surprise billing.” Anecdotes of patients going to a hospital in their network but unknowingly being served by a doctor outside of their network have prompted calls for greater transparency from hospitals and limits on out-of-network charges.

A number of proposals in Congress aimed at curtailing surprise billing have garnered bipartisan support. The Trump administration has indicated it would support legislation requiring doctors to provide written notice to patients before assigning them to an out-of-network specialist.

While much of the ire is directed at providers, the rise in surprise bills is likely largely due to insurers offering narrow networks that make it difficult for many members to find a physician or specialist covered by their plan.

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Surprise medical bills are becoming more common--and expensive

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