Purpose
Surprise out-of-network (OON) bills can represent a considerable cost burden on patients.
However, OON billing remains underexplored in elective, outpatient surgery procedures,
which have greater latitude for patient choice. We aimed to answer the following questions:
(1) What is the prevalence and magnitude of OON charges in hand surgery? (2) What
are the sources of OON charges? and (3) What factors are associated with OON charges?
Methods
We analyzed patient-level data from the Clinformatics Data Mart database. We identified
patients undergoing carpal tunnel release, trigger finger release, wrist ganglion
removal, de Quervain release, limited palmar fasciectomy, or thumb carpometacarpal
arthroplasty at in-network facilities with an in-network primary surgeon. The primary
outcome was the proportion of surgical episodes with at least 1 OON charge. Secondary
outcomes included the magnitude of potential balance bills (portion of OON bill exclusive
of the standardized payment and expected patient cost-sharing), sources of OON charges,
and factors associated with OON charges.
Results
Of 112,211 elective hand surgery episodes, 8% (9,158) had at least 1 OON charge. OON
charges ranged from $1,154 (95% confidence interval, $1,018–$1,289) for wrist ganglion
removal to $3,162 (95% confidence interval, $2,902–$3,423) for thumb carpometacarpal
arthroplasty. In episodes with OON charges, the major sources of OON charges were
anesthesiologists (75% of episodes), durable medical equipment (10% of episodes),
and pathologists (9% of episodes). Site of service, geographic region, and health
exchange-purchased plans were highly associated with OON charges.
Conclusions
Out-of-network billing can represent a substantial cost burden to patients and should
be considered in perioperative decision-making in elective hand surgery.
Clinical relevance
Understanding the potential costs related to OON services during a surgical episode,
and its drivers, allows surgeons to consider detailed cost discussions during perioperative
decision making.
Key words
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Article info
Publication history
Published online: August 01, 2022
Accepted:
June 1,
2022
Received:
October 3,
2021
Footnotes
Dr Kamal is consultant for Acumed and Triple ring and served at a committee position for American Academy of Orthopedic Surgeons and American Society for Surgery of the Hand. No benefits in any form have been received or will be received by the other authors 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.
