Feb 12, 2020 - Health

Elective surgery's surprise medical bill risk

Illustration: Lazaro Gamio/Axios

Even patients who plan elective surgeries with in-network doctors at in-network facilities have a pretty good chance of receiving a surprise medical bill, according to a new JAMA study.

Why it matters: Surprise bills are a problem for the patients who receive them, but also for the system as a whole, as they drive up overall health care costs.

The study found that 20.5% of elective surgeries — procedures like hysterectomies and knee replacements — performed at in-network facilities and by in-network primary surgeons resulted in an out-of-network bill.

  • These bills came from providers who patients usually have no hand in choosing, like surgical assistants, anesthesiologists and radiologists.

Details: These bills ranged, on average, from less than $100 to several thousand dollars, depending on the specialty and the procedure.

  • The average potential balance bill was $2,011.
  • The largest potential bills tended to be from surgical assistants and anesthesiologists, which also were the most frequent sources of out-of-network bills.
  • The South and Northwest had particularly high rates of these bills.

Go deeper: We all pay for surprise emergency room bills

Go deeper

How doctors have shaped the fight around surprise medical bills

Doctors' extensive lobbying on surprise medical bills is partly to blame for Congress' inaction on the issue, reports Kaiser Health News.

Why it matters: "As Congress begins its 2020 legislative session, there is evidence the doctors' message has been received: The bills with the most momentum are making more and more concessions to physicians."

Go deeperArrowFeb 13, 2020 - Health

White House seems to back insurers in fight over surprise bills

Photo: Brendan Smialowski/AFP via Getty Images

In the debate over surprise medical bills, the White House said today it's "concerned that a push to overuse arbitration will raise healthcare costs" — indicating that it's not on board with the approach doctors and hospitals prefer.

The big picture: Congress is gridlocked between two approaches, pitting insurers against providers. White House spokesman Judd Deere also said the administration believes surprise bills from air ambulances should be addressed in the same legislation.

Go deeper: Surprise medical bills inflate everyone's health insurance premiums

Senate Republicans are divided on drug costs and surprise medical bills

Photo: Tom Williams/CQ-Roll Call, Inc via Getty Images

Senate Majority Leader Mitch McConnell told reporters Tuesday that Senate Republicans are divided on bipartisan bills to address both drug costs and surprise bills, The Hill reports.

The big picture: The White House vocally supports the bipartisan drug pricing bill by Sens. Chuck Grassley and Ron Wyden.