Too often, patients are surprised to find a bill from an out-of-network provider involved in their treatment whom they had no control in choosing. Studies suggest that roughly 1 in 5 emergency room visits and 1 in 10 elective inpatient procedures result in the potential for a surprise out-of-network bill, most commonly when patients seek care at an in-network hospital but end up treated by certain emergency department or ancillary physicians (such as anesthesiologists, radiologists, pathologists, or assistant surgeons) who are outside their insurer’s provider network. The financial consequences can be devastating.
In recent years, many states have moved to address surprise billing and a few federal proposals are floating around Congress. While there is broad bipartisan agreement that a problem exists, a solution can sometimes prove elusive. On Friday, March 22, 2019, the USC-Brookings Schaeffer Initiative for Health Policy presented new analysis detailing policy approaches to eliminate surprise out-of-network billing and bring together policymakers and stakeholders to discuss crafting a solution.