All Publications

  • Assessment of Out-of-Network Billing for Privately Insured Patients Receiving Care in In-Network Hospitals. JAMA internal medicine Sun, E. C., Mello, M. M., Moshfegh, J., Baker, L. C. 2019


    Importance: Although surprise medical bills are receiving considerable attention from lawmakers and the news media, to date there has been little systematic study of the incidence and financial consequences of out-of-network billing.Objective: To examine out-of-network billing among privately insured patients with an inpatient admission or emergency department (ED) visit at in-network hospitals.Design, Setting, and Participants: A retrospective analysis using data from the Clinformatics Data Mart database (Optum), which includes health insurance claims for individuals from all 50 US states receiving private health insurance from a large commercial insurer was conducted of all inpatient admissions (n=5 457 981) and ED visits (n=13 579 006) at in-network hospitals between January 1, 2010, and December 31, 2016. Data were collected and analyzed in March 2019.Exposures: Receipt of a bill for care from at least 1 out-of-network physician or medical transport service associated with patient admission or ED visit.Main Outcomes and Measures: The incidence of out-of-network billing and the potential amount of patients' financial liability associated with out-of-network bills from the admission or visit.Results: Of 5 457 981 inpatient admissions and 13 579 006 ED admissions between 2010 and 2016, the percentage of ED visits with an out-of-network bill increased from 32.3% to 42.8% (P<.001) during the study period, and the mean (SD) potential financial responsibility for these bills increased from $220 ($420) to $628 ($865) (P<.001; all dollar values in 2018 US$). Similarly, the percentage of inpatient admissions with an out-of-network bill increased from 26.3% to 42.0% (P<.001), and the mean (SD) potential financial responsibility increased from $804 ($2456) to $2040 ($4967) (P<.001).Conclusions and Relevance: Out-of-network billing appears to have become common for privately insured patients even when they seek treatment at in-network hospitals. The mean amounts billed appear to be sufficiently large that they may create financial strain for a substantial proportion of patients.

    View details for DOI 10.1001/jamainternmed.2019.3451

    View details for PubMedID 31403651

  • Risk and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients With Newly Diagnosed Musculoskeletal Pain in the Neck, Shoulder, Knee, or Low Back ANNALS OF INTERNAL MEDICINE Moshfegh, J., George, S. Z., Sun, E. 2019; 170 (7): 504-505

    View details for DOI 10.7326/M18-2261

    View details for Web of Science ID 000463070700011

  • Anesthesia Care Team Composition and Surgical Outcomes ANESTHESIOLOGY Sun, E. C., Miller, T. R., Moshfegh, J., Baker, L. C. 2018; 129 (4): 700–709
  • Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain Jama Network Open Sun, E. C., Moshfegh, J., Rishel, C. A., Cook, C. E., Goode, A. P., George, S. Z. 2018; 1 (8)