7 specialties compared by surprise billing frequency

Emergency medicine specialists were most likely to generate "surprise bills," or out-of-network bills for services provided at in-network facilities, compared to six other specialties, according to an analysis by the Health Care Cost Institute, an independent, nonprofit research organization.

The analysis is based on national claims data for patients with employer-sponsored insurance in 2017. Claims for anesthesia, behavioral health, cardiovascular, emergency, pathology, radiology and surgery services were included. HCCI grouped claims into "visits" by compiling claims by individual patient, type of service and day, and then examined how many of those visits involved out-of-network claims.

How the seven specialties compare:

  1. Emergency medicine specialists — 16.5 percent of emergency visits resulted in a surprise bill from an emergency medicine specialist
  2. Pathologists — 12.9 percent
  3. Anesthesiologists — 8.3 percent
  4. Behavioral health provider — 6.7 percent
  5. Radiologist — 4.2 percent
  6. Surgeon — 2.1 percent
  7. Cardiovascular specialists — 2 percent

HCCI also found rates of surprise billing within each specialty varied widely between states. For example, 45 percent of patient visits involving pathology resulted in surprise bills from a pathologist in Connecticut, compared to just 1 percent in Maine.

Click here for a more detailed breakdown of out-of-network billing broken down by specialty and by state.


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