Out-of-network billing among privately insured reached more than 42% in 2016

Out-of-network billing became increasingly prevalent between 2010 and 2016 for privately insured patients in emergency department and inpatient settings at in-network hospitals, according to a new study published Aug. 12 in JAMA Internal Medicine.

The study — led by researchers from Stanford (Calif.) University — found that 32.3 percent of privately insured patients faced out-of-network bills after ED visits at in-network hospitals in 2010. That's compared to 42.8 percent in 2016.

Researchers found that the share of privately insured patients who faced out-of-network bills for inpatient admissions at in-network hospitals also increased, from 26.3 percent in 2010 to 42 percent in 2016.

The findings are based on a March analysis of more than 5.4 million inpatient admissions and more than 13.5 million emergency department visits between 2010 and 2016 in Optum's Clinformatics Data Mart database. The database includes health insurance claims for privately insured U.S. patients.

The average price for an out-of-network bill after an emergency department visit at an in-network hospital climbed from $220 in 2010 to $628 in 2016, according to the study. The average price for an out-of-network bill after an inpatient admission at an in-network hospital increased 153.7 percent to $2,040 over the same period. 

"Out-of-network billing appears to have become common for privately insured patients, even when they seek treatment at in-network hospitals. The mean amounts billed appear to be sufficiently large that they may create financial strain for a substantial proportion of patients," the study authors concluded.



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