US Inpatient Emergency Department Cases May Lead To Surprise Medical Bills

Published on

A new study, released by Health Affairs as a Web First, looks at surprise medical bills—an unexpected bill from an out-of-network provider or a bill from an out-of-network provider not chosen by a patient. Authors Christopher Garmon and Benjamin Chartock found that in 2014, 20 percent of US hospital inpatient admissions originating in the emergency department (ED), 14 percent of outpatient visits to the ED, and 9 percent of elective inpatient admissions likely led to a surprise medical bills.

This is a decrease from 2007 when those rates were nearly 28 percent, 18 percent, and 14 percent, respectively. The data evaluated were for 2007–14 and came from the Truven Health MarketScan Commercial Claims and Encounters Database. The authors reviewed claims for nonelderly patients with employer-sponsored health insurance.

Other key study findings:

  • The likelihood of receiving a surprise medical bill increased with a patient’s age and the complexity of his or her diagnosis.
  • Surprise medical bill rates for ED patients differed significantly across states, with the some of the highest 2014 rates in Florida (37 percent), New York (35 percent), and Texas (34 percent) (see the exhibit below).

While previously published research on this topic, including a recent Health Affairs Blog post, has covered this subject, this is the first study to analyze surprise medical bills using a data set of multiple health insurers across multiple years. As part of their conclusion, the authors note that the rate of surprise medical bills may be even higher for patients with Marketplace plans, since many of these plans have narrow hospital and physician networks, something Marketplace customers are likely not to realize.

This study, part of Health Affairs’ DataWatch series, will also appear in the journal’s January issue.

Enjoyed this video?
"No Thanks. Please Close This Box!"