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Editor's Note
February 11, 2020

Surprise Billing in Surgery—Time for Action

Author Affiliations
  • 1Washington University School of Medicine
  • 2Associate Editor, JAMA
  • 3Deputy Editor, JAMA
JAMA. 2020;323(6):547. doi:10.1001/jama.2019.21461

“Surprise” billing occurs when patients with health insurance receive care from a clinician or facility included in their insurer’s network (“in-network”) but unexpectedly receive “surprise” bills from other clinicians involved in their care who are not in the patient’s insurer’s network (“out-of-network”) and therefore not covered by their insurance. In this issue of the JAMA, Chhabra and colleagues1 present a thorough analysis of out-of-network billing for elective operations and find the practice to be both common and potentially financially devastating. Based on their analysis of 347 356 patients who had undergone 1 of 7 common elective operations with in-network surgeons at in-network facilities, the authors report that 20.5% of these surgical episodes also had an associated out-of-network bill, with a mean potential financial liability of more than $2000. The most common sources of the out-of-network bills were surgical assistants and anesthesiologists.

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