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Studies show that patients are more likely to receive so-called “surprise” medical bills from an anesthesiologist or after being treated in an emergency room.
Now a new study finds that hospitals mark up the prices for those services even more than for others.
Surprise medical bills, also known as “balance” bills, often happen when patients go to a hospital they think is in their insurance network but are treated by a doctor or specialist who is out-of-network. The result puts patients on the hook for very high bills – sometimes exceeding thousands of dollars.
The latest study, reported by Fierce HealthCare, examined markups across 2,042 U.S. hospitals from 2012 to 2016. Researchers specifically looked at the markup ratio, which sets charges for out-of-network patients based on the rate of Medicare reimbursement. They found the markup ratio for emergency trips increased from 3.9 to 5.1. A 5.1 ratio means that for every $100 in Medicare reimbursement, the hospital would charge $510 to out-of-network patients. In other words: a 410 percent markup.
The ratio for anesthesiology also increased from 6:1 in 2012 to 7:4 in 2016.
The markups “far exceeded economic inflation,” according to the study.
“These findings are particularly worrisome given that the incidence of emergency department surprise medical bills increased from 32 percent to 43 percent between 2010 and 2016,” researchers added.
Congress is considering how to eliminate surprise medical bills that come from out-of-network charges like these. There is bipartisan support for action, but no bills have moved forward because of intense lobbying from provider groups, according to FierceHealthcare.
Voice your concerns about surprise medical bills by filling out the official Voices for Affordable Health survey.