In: Nursing
surprise billing refers to a situation in which an insured patient receives an unexpected medical bill, usually from a physician who is outside of that patient's insurance network.
surprise billing occurs when an insured patient receives care from a source that is out of the individual's insurance network.
This can occur when a patient is brought to the closest hospital in an emergency, where physicians who are hired as independent contractors or by large firms may offer different insurance coverage.
Surprise billing has the potential to mark the patient-physician relationship, harm patients' health, and lead to behind the problems in health care.
For example :-
One in 10 insured adults have said they’ve received a surprise bill in the past year. The average surprise bill is more than $600, which is more than 40 percent of families would be able to pay without borrowing or selling something. Many surprise bills are thousands of dollars, with some greater than 600 percent more than Medicare would have paid for the same service.
Groups of physicians—particularly emergency physicians and anesthesiologists—stay out of insurance networks, raise terribly high bills on unaware patients, and maximize their revenue.