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Analysis

Even In-Network Colonoscopies Can Generate Surprise Bills

By Alexandra Wilson Pecci  
   October 13, 2020

Even when patients make all the right choices about which provider to use, they can get still get whacked with a surprise bill, a new study shows.

Even if they get their elective coloscopy from an in-network provider, many commercially insured patients still receive surprise bills for out-of-network expenses.

That's according to a new research report published in Annals of Internal Medicine.

Many progressive revenue cycle leaders are making efforts to educate patients about their health benefits, but this study shows that even when patients make all the right choices about which provider to use, they can get still get whacked with a surprise bill.

The research showed that nearly one in eight commercially insured patients nationwide who underwent an elective colonoscopy between 2012 and 2017 performed by an in-network provider received potential surprise bills for out-of-network expenses.

The main reason? The use of out-of-network anesthesiologists and out-of-network pathologists during the procedure.

University of Virginia and University of Michigan researchers reviewed 1.1 million claims from a large national insurer and found that 12.1% of cases received out-of-network claims, with an average surprise bill of $418.

This is bad news for revenue cycles that are making every effort to eliminate surprise for their patients. The researchers note that federal regulations eliminate consumer cost-sharing when screening colonoscopies are performed in-network.

Plus, the prospect of a getting a surprise bill might discourage patients from getting a colonoscopy, which is the most effective colorectal cancer prevention strategy.

The researchers suggest three solutions for eliminating surprise colonoscopy bills. One is making sure that endoscopists and hospitals only partner with anesthesia and pathology providers who are in-network.

Christopher Garmon, co-author of a Health Affairs study about surprise out-of-network maternity bills, suggested to HealthLeaders last year that hospitals make providers an ultimatum: "If you want to practice in my hospital … then you have to make a good-faith effort to be in network for all the health plans … so [we're] aligned."

The Annals of Internal Medicine authors also suggested money saving tactics for hospitals like using endoscopist-provided sedation, rather than deeper anesthesia, and not sending all low-risk polyps pathological evaluation.

Alexandra Wilson Pecci is an editor for HealthLeaders.


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