AARP Eye Center
About 1 in 7 hospital patients get a “surprise bill,” a charge for an out-of-network procedure or health care provider even when they were admitted to a hospital in their insurer’s network. The likelihood of being charged with a surprise bill varies by state and medical specialty, but Florida had the highest share of in-network hospital admissions with out-of-network claims, at 26.3 percent, according to a report by the Health Care Cost Institute.
California, Kansas and New Jersey were all over the 20 percent mark, which means 1 in 5 hospital patients got a bill for an out-of-network procedure or provider despite going to an in-network hospital. On the other end of the spectrum, only 1.7 percent of Minnesota hospital admissions resulted in out-of-network charges. The data comes from the Health Care Cost Institute’s examination of charges for hospital admissions in 2016 in 37 states and the District of Columbia.
AARP Membership — $12 for your first year when you sign up for Automatic Renewal
Get instant access to members-only products and hundreds of discounts, a free second membership, and a subscription to AARP The Magazine.
Those hit with the higher charges went to a hospital they thought was in their insurer’s network, which means prices for treatment, tests and care had been negotiated and set by the hospital and insurer, and the insurers paid a large share of the costs. Yet it turned out that some procedures or lab tests were conducted by an out-of-network health professional. This meant patients were billed for charges that were higher than those negotiated by the in-network providers.
This can happen for a variety of reasons, including the way hospitals and doctors form relationships with insurers.
Karen Pollitz, a senior fellow at the Kaiser Family Foundation, says that even though patients can ask if a specialist such as an anesthesiologist is in their insurance network, “they probably won’t know. Usually the one who participates in a surgery is the one who is on call that morning.”
That can mean the patient has no choice.
“The point is that they are surprise bills, so the patients are really stuck on this one,” Pollitz says.
In the Health Care Cost Institute’s study, the source of out-of-network providers varied by medical specialty. Physicians from these specialties accounted for the most frequent out-of-network bills when patients were admitted to in-network hospitals:
- Anesthesiology: 16.5 percent.
- Other physician: 13.5 percent.
- Primary care: 12.6 percent.
- Emergency medicine: 11 percent.