When Patients Can’t Choose: Out-of-Network Care Can Be Costly

MedicalResearch.com Interview with:

Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036

Dr. Ge Bai

Ge Bai, PhD, CPA
Assistant Professor
The Johns Hopkins Carey Business School
Washington, DC 20036 

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The average anesthesiologist, emergency physician, pathologist and radiologist charge more than four times what Medicare pays for similar services, often leaving privately-insured out-of-network patients stuck with surprise medical bills that are much higher than they anticipated.

The average physician charged roughly 2.5 times what Medicare pays for the same service. There are also regional differences in excess charges. Doctors in Wisconsin, for example, have almost twice the markups of doctors in Michigan (3.8 vs. two).

MedicalResearch.com: What should readers take away from your report?

Response: Most patients do not choose anesthesiologists, emergency physicians, pathologists, or radiologists and have no opportunity to anticipate these specialists’ network status. These specialists’ high charges affect not only the uninsured but also the well-insured treated by specialists out of their insurer’s network. It is particularly frustrating for patients who deliberately select an in-network hospital and in-network physician only to learn that some of the physicians involved in their care were out of network long after the care was delivered.

MedicalResearch.com: Is there anything else you would like to add?

 

Response: Protecting patients from surprise medical bills from out-of-network physicians is an important issue in the ongoing national debate about the affordability of health care.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Bai G, Anderson GF. Variation in the Ratio of Physician Charges to Medicare Payments by Specialty and Region. JAMA. 2017;317(3):315-318. doi:10.1001/jama.2016.16230

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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