Johns Hopkins Research Shows Patients Are Receiving Bills For Out-Of-Network Physicians They Did Not Select


According to a new research by Johns Hopkins Bloomberg School of Health, patients are being charged for out-of-network physician services. The patients are denying selecting to utilize these services for their medical procedures, but are still receiving large bills.


Medicare Pays Less Than A Physician Charges


Research published in the Journal of the American Medical Association shows that some of the physicians are charging six times more than what Medicare pays for similar services. Insurance companies utilize Medicare pricing as a gauge to determine payout for specific services

In some cases, the patients were left with only one option, which ended up being an out-of-network provider. For instance, a patient can choose the general surgeon to perform their appendectomy. However, if the patient is facing an emergency crisis, the only option available may be a general surgeon outside of the patient’s insurance network.

The study found that the average emergency doctor, pathologist, radiologist and anesthesiologist charge more than four times what Medicare pay for similar services. Median out-of-network patients in Maryland are paying around 220 percent more than the Medicare payout for the same service.

“There is no regulation that tells them how much they should charge and there are really no market forces that constrain how much the can charge either,” said Gerard F. Anderson, the study’s senior author and a professor in the Department of Health Policy and Management at the Bloomberg School. “Most of the time people don’t know how much they are getting charged after they get bill.”

The researchers combined the 2014 Medicare Provider Utilization and Payment data, along with data obtained from 400,000 physicians. Medicare rates were compared to the amount that physicians charge patients for medical services.

The researchers determined that federal legislation to require physicians to make patients aware they are out-of-network. This along with posting prices for services could help, but only in non-emergency situations.

States such as New York enforce laws that restrict the amount an out-of-network physician can charge. However, most of the rules only apply to emergency situations.

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