Study Shows Surprise Medical Bills due to Excess Charges

January 2017 ~

Consumer Reports found close to 30% of patients with private insurance received a “surprise” medical bill from 2014 through 2015.

A recent JAMA study examined this issue and it was found that of most physicians of the 429,273 studied – physicians in 54 specialties charged 2.5 times more than what Medicare pays them for their services in 2014. The findings show around a third of the physicians with the highest excess charges were confined to only ten hospital referral regions.

As stated in the study: “Nearly all physicians charge more than the Medicare program actually pays, with complete discretion to determine the amount charged. High excess charges can impose financial burdens on uninsured patients and privately insured patients using out-of-network physicians. Although some out-of-network physicians may offer discounts from their full charges, many patients receive unexpected medical bills. A national study was conducted to understand the extent and variation of physician excess charges.”

The authors conclude that this this occurrence of surprise charges is most likely due to the large number of physicians providing out-of-network services to a patient at an in-network facility and billing patients for the costs beyond what insurance will pay, noting, “As the health insurance market shifts toward more restrictive physician networks and high-deductible plans, protecting uninsured and out-of-network patients from high medical bills should be a policy priority.”

Access JAMA’s complete study: Variation in the Ratio of Physician Charges to Medicare Payments by Specialty and Region and finding details, here.

Source(s): HealthcareDIVE; JAMA;