About half of patients who received health care outside of their insurance network did not know how much they would have to pay for their out-of-network care at the time of treatment, according to a recently published study.

Researchers analyzed data from a survey of 7,812 individuals in private health insurance plans with provider networks, who utilized health services within the previous 12 months. Details of inpatient and outpatient contacts with out-of-network physicians were reported.

Overall, 8% of participants used an out-of-network physician and 40% of participants using an out-of-network physician experienced involuntary out-of-network care. Study results showed that 58% of out-of-network physician inpatient contacts and 15% of outpatient contacts were involuntary, and half were due to medical emergencies. At the time of contact, 31% of the physicians’ out-of-network status was unknown. Fifty-two percent of participants experienced at least one contact with an out-of-network physician where cost was not transparent at the time of care, according to study results.

“It’s important that treatment always be the priority over cost in emergency situations, but there is room for more transparency and reform to address the unexpected out-of-network cost burden that a lot of patients end up facing,” Kelly Kyanko, MD, of New York University School of Medicine, stated in a press release. “It can often be difficult to obtain an estimate of how much you will be charged by a doctor because they don’t publicize prices, and patients may not know what the doctor will recommend. If patients plan to go out-of-network, they should call both the doctor to obtain an estimate of costs as well as the insurer to see how much they will reimburse.”

For more information:

Kyanko K. Health Serv Res. 2012;doi:10.1111/1475-6773.12007.

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