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Member Research & Reports

Member Research & Reports

Yale: Study Exposes Surprise Billing by Hospital Physicians

Patients with private health insurance face a serious risk of being treated and billed by an out-of-network doctor when they receive care at in-network hospitals, according to a new study by Yale researchers. Addressing the issue could reduce health spending by 3.4 percent — $40 billion annually, the researchers conclude.

The study, published Dec. 16 in the journal Health Affairs, analyzes 2015 data from a large commercial insurer covering tens of million of individuals throughout the United States to show that anesthesiologists, pathologists, radiologists, and assistant surgeons at in-network hospitals billed out of network in about 10 percent of cases.

“When physicians whom patients do not choose and cannot avoid bill out of network, it exposes people to unexpected and expensive medical bills and undercuts the functioning of U.S. health care markets,” said Dr. Zack Cooper, associate professor of public health at the Yale School of Public Health and in the Department of Economics, and one of the study’s authors. “Moreover, the ability to bill out of network allows specialists to negotiate inflated in-network rates, which are passed on to consumers in the form of higher insurance premiums.”

The study, which was supported by the James Tobin Center for Economic Policy at Yale, adds to a body of work by Cooper and his colleagues analyzing the causes of surprise medical billing in the United States. A 2018 study in the New England Journal of Medicine found that over 1 in 5 patients who went to in-network emergency departments were treated by out-of-network emergency physicians.

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