© 2023 Connecticut Public

FCC Public Inspection Files:
WPKT · WRLI-FM · WEDW-FM · Public Files Contact
Play Live Radio
Next Up:
0:00 0:00
Available On Air Stations
Cancer Answers is hosted by Dr. Anees Chagpar, Associate Professor of Surgical Oncology and Director of The Breast Center at Smilow Cancer Hospital at Yale-New Haven Hospital, and Dr. Francine Foss, Professor of Medical Oncology. The show features a guest cancer specialist who will share the most recent advances in cancer therapy and respond to listeners questions. Myths, facts and advances in cancer diagnosis and treatment are discussed, with a different focus eachweek. Nationally acclaimed specialists in various types of cancer research, diagnosis, and treatment discuss common misconceptions about the disease and respond to questions from the community.Listeners can submit questions to be answered on the program at canceranswers@yale.edu or by leaving a message at (888) 234-4YCC. As a resource, archived programs from 2006 through the present are available in both audio and written versions on the Yale Cancer Center website.

Yale Study: Surprise Medical Bills Generated By Out-Of-Network Doctors At In-Network Hospitals

Healthcare provider helps cancer patient.
SDI Productions
Getty Images
Young female home healthcare professional helps an elderly woman get out of bed by using a walker. The woman is wearing a cap on her head. An iv drip is in the background.

Even when patients go to a hospital within their insurance coverage network, they still risk being seen by individual physicians who don’t take their insurance. Later, patients may get billed for the amount their insurance company doesn’t cover for out-of-network services.

new study by researchers at Yale University found that some of these out-of-network charges can be significant among certain specialties.

“So you go in to get a surgery, you do everything right -- you find an in-network surgeon at an in-network hospital,” said Zack Cooper, a Yale associate professor of public health and economics. “We still don’t have choice over who your anesthesiologist is or who the radiologist is reviewing some of your material. And it turns out the bills from those physicians can be pretty sizable.”

Cooper was on a team of researchers that looked at 3.9 million cases of people who had private insurance through a large commercial insurer. The studied cases involved at least one of four specialists: anesthesiologists, pathologists, radiologists and assistant surgeons.

Researchers said these are hospital-based physicians who are often not chosen by patients prior to a procedure or health care service.

According to the study findings, specialists billed for out-of-network services in about 10% of cases overall -- and the billing amounts varied. The highest mean out-of-network charge to patients came from assistant surgeons at $7,889.

Second was $2,130 for anesthesiologists, followed by $311 for pathologists and $194 for radiologists.

Cooper said most physicians at in-network hospitals provide in-network care. The problem is the small percentage of physicians and specialists who operate as out-of-network doctors at these in-network facilities.

“And their ability to be out-of-network without us choosing them or being able to avoid them raises the cost of health care in the U.S.,” he said, “and that gets passed along to all of us in the form of higher insurance premiums.”

The study concluded that out-of-network billing by these specialists was more prevalent at for-profit hospitals and at hospitals that operated in markets with little competition.

States like New York and California have adopted their own consumer protection laws to try to end these types of surprise medical bills. In New York, insurance companies and out-of-network physicians must use arbitration to settle payment disputes.

The system was designed to protect patients from getting charged the disputed amount, a practice called balance billing. But an analysis of data released by the New York Department of Financial Services concluded that the arbitration process is making health care more expensive for the state’s residents.

California uses a type of benchmarking system in which the state, using a formula, limits the amount insurers must pay physicians for out-of-network services by calculating what other doctors are getting paid.

Cooper said solving the issue at a national level could reduce health care spending in the United States by 3.4%, or about $40 billion annually.

Lawmakers in Washington, D.C., were working on a federal law to end surprise medical bills, but that legislation was ultimately not included in a government spending package that passed in December.

Nicole Leonard joined Connecticut Public Radio to cover health care after several years of reporting for newspapers. In her native state of New Jersey, she covered medical and behavioral health care, as well as arts and culture, for The Press of Atlantic City. Her work on stories about domestic violence and childhood food insecurity won awards from the New Jersey Press Association.

Stand up for civility

This news story is funded in large part by Connecticut Public’s Members — listeners, viewers, and readers like you who value fact-based journalism and trustworthy information.

We hope their support inspires you to donate so that we can continue telling stories that inform, educate, and inspire you and your neighbors. As a community-supported public media service, Connecticut Public has relied on donor support for more than 50 years.

Your donation today will allow us to continue this work on your behalf. Give today at any amount and join the 50,000 members who are building a better—and more civil—Connecticut to live, work, and play.

Related Content