The types of doctors who can “surprise bill” meaning they are likely an out-of-network provider who is performing an emergency treatment or procedure on a patient — such as an anesthesiologist or emergency room doctor — charge a lot more when a patient does not have the required health insurance, according to data released by The Brookings Institute.
The average out-of-network charges assessed by anesthesiologists have increased by 6.7% annually between 2012 and 2017 when compared to the rates those physicians charged Medicare for the same services, according to the analysis. For emergency room physicians, the average increase was 4.4% higher than what Medicare was charged.
When looking at the data geographically, anesthesiologists in Wisconsin charge 11 times higher for out-of-network patients than the average Medicare patient.
Surprise billing has been a major issue for the healthcare industry. A surprise bill occurs when a patient goes to a hospital, usually for an emergency situation, and is treated by doctors who are not part of the patient’s insurance coverage. While the hospital may take the patient’s insurance, there might be certain doctors who are not part of that coverage. The patient then receives a unexpected bill from those physicians after he or she leaves the hospital. In many cases, a patient in an emergency is not in a position to check whether a doctor is part of his or her insurance plan and consider going to another facility.
A number of states, as well as the federal government, are considering legislative solutions to limit how much an individual can be charged in a surprise billing situation.
About one out of every six emergency room visits leads to an individual receiving a surprise medical bill for out-of-network coverage, according to a study
