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Data: Health Affairs; Chart: Axios Visuals

Four specialties that are often out-of-network — anesthesiologists, pathologists, radiologists and assistant surgeons — raise employer insurance spending by 3.4%, according to a new study in Health Affairs.

Why it matters: Surprise medical bills are not only unaffordable for the patients who receive them, but also inflate everyone else's premiums.

Between the lines: Providers are more likely to be out-of-network at for-profit hospitals and those located in concentrated markets, the study found.

  • These four specialties are providers that patients don't choose. They ultimately get paid several times more than they'd make from treating a Medicare patient.
  • In contrast, orthopedists performing knee surgeries — which patients do have the ability to choose — were paid 164% of Medicare rates, on average.
  • The study's authors argue that these four specialties can use the threat of billing patients directly to gain leverage in negotiations with insurers.

By the numbers: If the payment rates for these four specialties were reduced to 164% of Medicare, total physician spending among privately insured patients would be reduced by 13.4%, or $40 billion a year for people with employer coverage, the study found.

  • That's exactly why providers are fighting so hard against Congress' efforts to include a benchmark payment rate for out-of-network care as part of a surprise billing solution.
  • Whatever they spend in lobbying is, comparatively, chump change.

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Illustration: Sarah Grillo/Axios

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