Table 3. Annual Incidence and Magnitude of Out-of-Network Billing for Inpatient Admissions.
| Year | No. of Admissionsa | Admissions With Out-of-Network Bill, No. (%)b | Potential Out-of-Network Responsibility, $c | |||||
|---|---|---|---|---|---|---|---|---|
| Mean (SD) | 10th | 25th | 50th | 75th | 90th | |||
| 2010 | 607 160 | 159 609 (26.3) | 804 (2456) | 0 | 30 | 285 | 794 | 1684 |
| 2011 | 573 457 | 175 610 (30.6) | 990 (2876) | 0 | 73 | 389 | 971 | 2060 |
| 2012 | 830 824 | 301 568 (36.3) | 1277 (3899) | 0 | 125 | 508 | 1194 | 2568 |
| 2013 | 867 523 | 338 715 (39.0) | 1483 (4188) | 16 | 192 | 653 | 1428 | 2950 |
| 2014 | 803 425 | 327 676 (40.8) | 1731 (4698) | 25 | 244 | 760 | 1682 | 3474 |
| 2015 | 828 481 | 319 297 (38.5) | 1920 (5157) | 35 | 291 | 853 | 1842 | 3791 |
| 2016 | 947 111 | 397 447 (42.0) | 2040 (4967) | 44 | 325 | 984 | 2084 | 4112 |
| Overall | 5 457 981 | 2 019 922 (37.0) | 1574 (4382) | 8 | 183 | 667 | 1538 | 3215 |
a
Total annual inpatient admissions to an in-network hospital.
b
Number of inpatient admissions with at least 1 claim submitted by an out-of-network physician or medical transport service.
c
Patient’s responsibility for out-of-network services reported by percentiles and defined as the difference between the physician or medical transport charge and the amount typically paid by the insurer for an in-network service. These amounts are in addition to any other out-of-pocket payments (eg, payments for deductible and coinsurance). All dollar values are adjusted to 2018 US$.