GUEST BLOG AUTHOR: Payton Stredler, University of Virginia, BA 2022, MPP 2023 (Summer 2021 U.S. PIRG Health Care Campaigns Intern)
Surprise out-of-network medical billing continues to increase costs for patients, even when they pre-plan their hospital stay and seek care at an in-network hospital. A new study shows that almost one in five families who delivered their newborn at an in-network hospital in 2019 was at risk for receiving an out-of-network bill for the delivery, infant hospitalization or both. The median bill came to $744, but one-third of families received out-of-network bills over $2,000. Childbirth is the most common reason for hospital inpatient stays and is almost always pre-planned. These families had plenty of time to find in-network providers and hospitals. So, why are so many insured families receiving surprise out-of-network medical bills for childbirth-related care?
The study showed surprise bills were larger and more frequent in births that involved C-sections or neonatal intensive care – services that involve providers that tend to remain out-of-network. C-section bills tended to be on the higher end, averaging $1,825. Anesthesia was the most common reason for potential surprise bills related to delivery. Since women who need C-sections will need anesthesia, and many women who deliver vaginally opt for an epidural, it is only reasonable that a patient would expect those services to be covered at their in-network hospital.
Neonatal intensive care commonly creates surprise bills as well. When parents seek an in-network facility to bring their newborn into the world, they expect the facility to offer critical emergency services to the infant if needed. Often, these services fall out-of-network and result in a staggering and surprising charge.
Labor and delivery is rarely an “unexpected” service. Families actively seek and choose in-network hospitals and providers when it comes to having a baby. The study underscores that certain specialties, such as anesthesiologists who have a captive client once a patient is admitted, are more likely to remain out-of-network, giving them the freedom to send a surprise bill.
However, beginning in January 2022, the federal No Surprises Act should put an end to these most common surprise bills related to childbirth. Congress recognized the need to protect patients from unavoidable out-of-network charges and took action. The new law specifically prohibits surprise bills for services related to anesthesiology, neonatology, radiology, pathology, and diagnostic testing. Assistant surgeons, hospitalists and intensivists are also prohibited from billing for out-of-network care.
Though the No Surprises Act will limit surprise billing, pregnant women and new parents can still be susceptible to surprise bills. Providers at an in-network hospital who aren’t specifically prohibited in the new law from sending a surprise bill, such as plastic surgeons, could ask patients to sign a consent form allowing the out-of-network service and opening the door to a surprise bill. As with any law, certain providers may violate the ban and send patients illegal bills. Families will still need to be vigilant reading their bills and reporting violations to their insurer and the authorities listed on their 2022 medical bills. And because the new law omits surprise billing protections from out-of-network ground ambulances, parents could face expensive charges if they need emergency ground transport to a hospital to deliver their baby.
Until the No Surprises Act goes into effect, families should do their best to protect themselves from surprise medical bills. Check out our state-specific consumer tips and use these general guidelines.
Work with your insurance company to ensure in-network care throughout pregnancy and childbirth. Ask specifically about anesthesia and neonatal intensive care in-network coverage.
Think carefully before signing a consent form agreeing to out-of-network care as it will likely mean you will be paying much more out of pocket.
Always insist on an in-network option for service at your in-network facility.
Review your bills afterwards and flag any charges that seem inaccurate.
Having a baby is already expensive enough. No one wants to start eighteen years of buying food, clothes, school supplies, toys, with an unnecessary medical bill. Surprise medical bills from providers at in-network hospitals are more common than you might think. Protect yourself from potential surprise medical bills and save more money for diapers and babysitters!
Photo credit: Image by Joe Yates via Unsplash
Senior Director, Health Care Campaigns, U.S. PIRG Education Fund
Patricia directs the health care campaign work for U.S. PIRG and provides support to our state offices for state-based health initiatives. Her prior roles include senior director of health policy with the National Consumers League, senior policy advisor at NJ Health Care Quality Institute, and consumer advocate at NJPIRG. She serves on the board of the Patient and Caregiver Engagement Advisory Group for the National Quality Forum. Patricia enjoys walks along the Potomac and sharing her love of books with her friends and family around the world.