Table 4. Incidence and Magnitude of Out-of-Network Billing for Medical Transport Services and the 10 Most Common Physician Specialties for Inpatient Admissions.
| Specialty | No. of Admissionsa | Admissions With Out-of-Network Bill, No. (%)b | Potential Out-of-Network Responsibility, $c | |||||
|---|---|---|---|---|---|---|---|---|
| Mean (SD) | 10th | 25th | 50th | 75th | 90th | |||
| Radiology | 3 181 749 | 720 698 (22.6) | 267 (759) | 15 | 33 | 121 | 307 | 615 |
| Emergency medicine | 2 132 940 | 908 430 (42.6) | 595 (575) | 44 | 203 | 477 | 858 | 1267 |
| Internal medicine | 2 007 554 | 507 014 (25.3) | 450 (1133) | 9 | 65 | 206 | 483 | 999 |
| Anesthesiology | 1 961 192 | 378 239 (19.3) | 1369 (1807) | 0 | 233 | 794 | 1825 | 3362 |
| Cardiology | 1 701 819 | 333 769 (19.6) | 328 (1438) | 10 | 19 | 52 | 196 | 612 |
| Unknown | 1 115 844 | 214 992 (19.3) | 544 (1489) | 29 | 106 | 265 | 614 | 1136 |
| Pathology | 987 225 | 219 335 (22.2) | 297 (542) | 16 | 63 | 145 | 303 | 676 |
| Medical transport | 947 744 | 773 218 (81.6) | 424 (2176) | 0 | 0 | 44 | 365 | 832 |
| Family practice | 783 703 | 142 455 (18.2) | 384 (1330) | 0 | 49 | 148 | 364 | 798 |
| Obstetrics & gynecology | 760 049 | 6220 (0.8) | 1228 (3457) | 18 | 91 | 293 | 1075 | 1075 |
a
Total inpatient admissions with at least 1 claim submitted by the given specialty.
b
Total inpatient admissions with at least 1 out-of-network claim submitted by the given specialty.
c
Patient’s responsibility for out-of-network services reported by percentiles and defined as the difference between the physician or medical transport charge and the amount typically paid by the insurer for an in-network service. These amounts are in addition to any other out-of-pocket payments (eg, payments for deductible and coinsurance). All dollar values are adjusted to 2018 US$.