Feb 12, 2020 - Health

Elective surgery's surprise medical bill risk

Caitlin Owens, author of Vitals

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

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