Purpose
Patients may receive surprise out-of-network bills even when they present to in-network
facilities. Surprise bills are common following emergency care. We sought to characterize
and determine risk factors for surprise billing in hand and upper extremity trauma
patients in the emergency department (ED).
Methods
We used IBM MarketScan data to evaluate hand and upper extremity trauma patients who
received care in the ED from 2010 to 2017. Our primary outcome was the surprise billing
incidence, defined as encounters in in-network EDs with out-of-network claims. We
used descriptive and bivariate analyses to characterize surprise billing and used
multivariable logistic regression to evaluate independent factors associated with
surprise billing.
Results
Of 710,974 ED encounters, 97,667 (14%) involved surprise billing. The incidence decreased
from 26% in 2010 to 11% in 2017. Mean coinsurance payments were higher for surprise
billing encounters and had double the growth from 2010 to 2017 compared to those without
surprise billing. Receiving care from different provider types—especially therapists,
radiologists, and pathologists, as well as hand surgeons—was associated with significantly
higher odds of surprise billing. Transfer to another facility was not significantly
associated with surprise billing.
Conclusions
Although the incidence of surprise billing decreased, more than 10% of patients treated
in an ED for hand trauma remain at risk. Coinsurance for surprise billing encounters
increased by twice as much as encounters without surprise billing. Patients requiring
services from therapists, radiologists, pathologists, and hand surgeons were at greater
risk for surprise bills. The federal No Surprises Act, passed in 2020, targets surprise
billing and may help address some of these issues.
Clinical relevance
Many hand and upper extremity patients requiring ED care receive surprise bills from
various sources that result in higher out-of-pocket costs.
Key words
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Article info
Publication history
Published online: November 08, 2021
Accepted:
September 2,
2021
Received:
March 30,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
