Patients are often unsuccessful when negotiating bills for out-of-network emergency care and for care provided by out-of-network physicians at in-network hospitals, according to new research in The American Journal of Managed Care.
For the study, researchers Kelly A. Kyanko, MD, and Susan H. Busch, PhD, conducted a 2011 internet survey on out-of-network care on a nationally representative sample of 721 privately insured adults age 18 to 64.
The survey found only 19 percent of bills for out-of-network visits were negotiated, and patients who tried to negotiate were successful in lowering their costs 56 percent of the time. Patients who did try to negotiate were more likely to be successful negotiating with providers compared with insurers (63 percent compared to 37 percent), researchers found.
Researchers also identified disparities by gender and health status. The survey showed men were more likely than women to be successful in lowering their costs (76 percent compared to 50 percent). Researchers said out-of-network bills for emergencies, providers at in-network hospitals and with a balance bill were also more likely to be negotiated, although bills from providers at in-network hospitals and with balance bills were less likely to be successfully negotiated.
"Policy makers aiming to protect patients under these scenarios should consider policies that allow for an easily accessible, formal, and unbiased mediation process," the researchers concluded.
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