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Physicians Collected More for Likely Surprise Bills Compared to Other Cases

Analysis  |  By Jack O'Brien  
   April 05, 2021

The study found that more than $64 million of additional out-of-pocket payments are made each year to physicians providing emergency care out of network compared to what would have been paid for in-network care.

Physicians collected more for likely surprise bills compared to other cases, according to a Health Affairs study released Monday afternoon.

The research, based on data from the Medical Expenditure Panel Survey over the course of 15 years, stated that on average, physicians collected 65% of the charged amount for likely surprise bills, compared to 52% for other cases.

Additionally, patients that received an out-of-network surprise medical bill paid physicians more than 10 times as much as other emergency patients did. 

The study's researchers indicated that enhanced consumer protections tackling surprise billing would address a costly issue in healthcare.

"Back-of-the-envelope calculations using our estimates suggest that there were more than $64 million per year in additional out-of-pocket payments made to physicians for emergency care provided out of network compared with what patients would have paid for the same care in-network," the researchers wrote. "Taken together, this implies that there is considerable scope for consumer protection legislation to reduce patients’ financial burden associated with surprise out-of-network bills."

Related: Bipartisan Surprise Billing Legislation Gets Conditional Support from AHA

Nearly 5% of emergency department (ED) visits for privately insured patients between 18 to 64-years-old contained surprise medical bills 

The study also found that the "average physician payment to-charge ratios for likely surprise bill visits decreased as total physician charges increased," while all other ED visits remained constant.

Related: ACA Subsidies Associated with Lower Out-of-Pocket Spending

One other notable finding from the report was that patients with surprise medical bills paid $151 in out-of-pocket physician payments compared to $15 for all other ED visits.

Related: Millennials Have More Surprise Bills, Less Savings

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.


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