Understanding Surprise Out-of-Network Billing in Hand and Upper Extremity Care. [Review]
Citation: Journal of Hand Surgery - American Volume. 46(3):236-240, 2021 03.PMID: 33358882Department: Curtis National Hand CenterForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Hand | *Insurance, Health | Emergency Service, Hospital | Fees and Charges | Hand/su [Surgery] | Health Policy | Humans | United StatesYear: 2021Local holdings: Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - presentISSN:- 0363-5023
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 33358882 | Available | 33358882 |
Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - present
Surprise billing occurs when insured patients receive unexpected out-of-network charges and fees even when the emergency department, facility, or primary physician who provided care is in their insurance network. This issue is particularly relevant for hand surgery. The multidisciplinary nature of hand care and the number of ancillary services involved result in various levels at which out-of-network billing can be introduced, even when the hand surgeon is in-network for the patient. In addition, surprise billing is often associated with emergency department encounters, elective surgeries, and ambulance and helicopter transfers. In this article, we review surprise billing as it pertains to hand surgery. Little is known about surprise billing in hand care; however, we believe that these practices may substantially affect the patient population. We define key elements of surprise billing, review the literature, discuss the relevance and potential of surprise billing in hand surgery in various settings, and provide an overview of the status of health policy surrounding this practice. It is imperative for hand surgery as a field to understand the prevalence, operationalization, and policies of surprise billing better to prevent the exploitation of patients. Copyright (c) 2020 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
English