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TUESDAY, Oct. 13, 2020 (HealthDay News) — Out-of-network claims were incurred by 12.1 percent of commercially insured patients who underwent elective colonoscopy between 2012 and 2017, according to a study published online Oct. 12 in the Annals of Internal Medicine<\/i>.<\/p>\n
James M. Scheiman, M.D., from the University of Virginia in Charlottesville, and colleagues estimated the prevalence, amount, and source of out-of-network claims for commercially insured patients undergoing elective colonoscopy. Data were included for 1,118,769 elective colonoscopies with in-network endoscopists and facilities.<\/p>\n
The researchers found that 12.1 percent of the endoscopies involved out-of-network claims, with a median potential surprise bill of $418. Sixty-four percent of the cases involved out-of-network anesthesiologists (median potential surprise bill, $488), while 40 percent involved out-of-network pathologists (median potential surprise bill, $248). Compared with cases without intervention, when an intervention was done during colonoscopy, the likelihood of an out-of-network claim was significantly higher (13.9 versus 8.2 percent). When interventions were performed, 56 and 51 percent of potential surprise bills involved anesthesiologists and pathologists, respectively. Ninety-five percent of surprise bills involved anesthesiologists in cases with visual inspection only.<\/p>\n
“It is essential to develop tools that provide patients an estimate of their financial responsibility before their colonoscopy is done and better protect them from potential financial harm,” the authors write.<\/p>\n
Two authors disclosed ties to the health insurance industry and one disclosed ties to the pharmaceutical industry.<\/p>\n
Abstract\/Full Text (subscription or payment may be required)<\/a><\/p>\n <\/i><\/p>\n