Anesthesia and Pathology Charges Lead to Surprise Billing in Commercially Insured Colonoscopy
Douglas K. Rex, MD, MASGE, reviewing Scheiman JM, et al. Ann Intern Med 2020 Oct 13.
This study reviewed colonoscopies identified in a claims database from a large national insurer in the United States. The database was queried for commercially insured patients, ages 16 to 64 years, who underwent elective colonoscopy between 2012 and 2017 at a facility and with an endoscopist that were both in-network.
Of 1,118,769 colonoscopies, 12.1% incurred a claim associated with a “surprise” out-of-network median bill of $418 (interquartile range, $152-$981). Anesthesiologists were involved in 64% of these claims (median potential surprise bill, $488) and pathologists in 40% (median surprise bill, $248).
An out-of-network claim was more likely in cases involving an intervention than those with no intervention (13.9% vs 8.2%), presumably because of pathology bills.
In the discussion, the authors remind us that Section 2713 of the Patient Protection and Affordable Care Act eliminates consumer cost-sharing for screening colonoscopy.
COMMENTIdentifying potential surprise billing from anesthesiologists and pathologists for elective endoscopic procedures will be challenging and costly but will obviously be an important service to patients.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Scheiman JM, Fendrick AM, Nuliyalu U, Ryan AM, Chhabra KR. Surprise billing for colonoscopy: the scope of the problem. Ann Intern Med 2020 Oct 13. (Epub ahead of print) (https://doi.org/10.7326/M20-2928)
