Karen Pollitz, the study?s co-author.
That complicates research. And patients wonder whether they?ll make it out the hospital door without bumping into an out-of-network assistant surgeon or radiologist.
?It just feels like a minefield, you know,? Pollitz said.
Nationally, experts know some hospitals are far worse than others, though it?s difficult to pinpoint the culprits behind wide regional and even local disparities. And situations can vary year by year, as insurance networks change, as hospitals buy up physician groups, or as new staffing companies land on the scene with business models built around aggressive billing.
The Kansas Insurance Department doesn?t oversee the nitty-gritty details of insurer-provider contracts that might shed light on Kaiser?s analysis of Kansas claims. The kind of private insurance studied by Kaiser overwhelmingly falls under federal, not state, law.
Where logic fails
Patients often don?t realize they?ve received out-of-network services until an extra bill arrives from a provider they never chose.
?The anesthesiologist is who?s on call when you show up,? Pollitz said. ?If you?re having cancer surgery, you?ll never meet the pathologist who looks at your slides.?
Laura Burton made the common assumption that the doctors walking the halls of her in-network hospital in Topeka work for that hospital and fall in the same network.
?Absolutely,? she said. ?One hundred percent, that?s what I believed.?
Then came a letter from a Michigan mailing address demanding $400 for a pediatrician employed by an external staffing firm who checked on baby Amelia soon after her 2014 birth.
?It was not something we could pay off off-hand,? Burton recalled. ?Who would ever anticipate that a random physician would come in who wouldn?t be covered??
After a pregnancy full of complications, her bills surpassed her deductible and out-of-pocket maximum well before labor. She and her husband went into the final stretch thinking delivery wouldn?t cost more. They paid off the unpleasant surprise gradually.
A Federal Reserve survey found an unexpected $400 bill would cause problems for 40% of U.S. adults, making them borrow money, sell property or fall behind on credit card debt. And surprise bills are, by definition, impossible to plan for.
