20% of inpatient ED visits likely linked to surprise billing in 2014

One in five inpatient emergency department admissions likely resulted in a surprise medical bill from an out-of-network provider in 2014, a study published in Health Affairs found.

Researchers analyzed Truven Health MarketScan Commercial Claims and Encounters Database data from 2007 to 2014. The data include facility and physician claims indicating if a provider was in network or not. Researchers restricted data to patients covered by health plans which incentivized in-network treatment. 

Here are five findings from the study.

1. Twenty percent of hospital inpatient admissions originating in the ED led to a surprise medical bill in 2014. Fourteen percent of outpatient visits to the ED and 9 percent of elective inpatient admissions also likely led to surprising billing in 2014.

2. Rates of surprise billing in 2014 decreased from rates in 2007. Twenty-eight percent of hospital inpatient admissions originating in the ED, 18 percent of outpatient visits to the ED and 14 percent of elective inpatient admissions likely led to a surprise bill in 2007.

3. Highly-populated states like Florida had larger percentages of inpatient admissions from the ED with potential surprise medical bills (37 percent), followed by New York (35 percent) and Texas (34 percent).

4. In more than half of ambulance transportation cases, ambulance services were billed out of network, and in about half of these cases, claims were paid on an out-of-network basis.    

5. About 40 percent of inpatient admissions and slightly more than a half of outpatient cases with potential surprise medical bills received claims paid on an in-network basis.    

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