Health

Nearly 1 in 5 deliveries could lead to a surprise medical bill, study finds

A new study found that nearly 1 in 5 families with in-network insurance potentially received a surprise medical bill for childbirth or related maternal care.

The study, published Friday in the Journal of the American Medical Association, estimated that the average liability for a surprise medical bill was $744. The study comes as the federal government is taking steps to outlaw the practice.

“Surprise bills were more frequent and larger when cesarean delivery or neonatal intensive care occurred,” the study said.

Researchers included 95,384 families who were linked to 96,881 newborn hospitalizations in 2019. It looked at 2019 data from Optum’s Clinformatics Data Mart that has 12 million privately insured enrollees.

It identified a potential surprise bill as a professional claim from an out-of-network clinician or ancillary service provider.

“We estimated the liability for these bills by subtracting typical in-network reimbursement charges,” the study said.

RELATED: Surprise billing rule also strikes down insurer ED policies

The study found that nearly 20% of the families had one or more potential surprise bill for “delivery, newborn hospitalizations or both.”

Surprise bills could range based on the types of service provided. For instance, a delivery had one or more potential surprise medical bills with an average liability of $900.

However, a cesarean delivery had a potential liability of $1,825, the study said.

“For one-third of families that received potential surprise bills, the estimated liability exceeded $2,000,” the study added.

Researchers noted that the study lacked information on whether families received a surprise bill or the actual amounts paid.

While outlawing surprise billing is a good first step, more needs to be done to help protect families from unexpected financial burden, the JAMA study said.

“Notably, the high frequency of out-of-network care in our study, coupled with the fact that childbirth is the most common reason for hospitalization, suggests that childbirth hospitalizations are currently one of the most frequent sources of surprise bills in the U.S.,” the study said.

The study comes as the Biden administration last week released the first in a series of regulations that outlaw the practice of surprise medical bills. The interim final rule takes effect on Jan. 1, 2022, and bans any surprise bills for emergency services and any out-of-network charges without advance notice.

The administration plans to issue more regulations on how an independent arbitration process will work for disputes between payers and providers over out-of-network charges.

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