Surprise Billing for Colonoscopy: The Scope of the Problem
Authors: James M. Scheiman, A. Mark Fendrick, Ushapoorna Nuliyalu, Andrew M. Ryan, Karan R. Chhabra
Journal: Annals of Internal Medicine (2020)

LettersMarch 2021Surprise Billing for Colonoscopy: The Scope of the ProblemJames M. Scheiman, MD, A. Mark Fendrick, MD, Ushapoorna Nuliyalu, MPH, Andrew M. Ryan, PhD, Karan R. Chhabra, MD, MScJames M. Scheiman, MDUniversity of Virginia, Charlottesville, Virginia, A. Mark Fendrick, MDCenter for Value-Based Insurance Design and School of Public Health, University of Michigan, Ann Arbor, Michigan, Ushapoorna Nuliyalu, MPHCenter for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan , Andrew M. Ryan, PhDCenter for Healthcare Outcomes and Policy, School of Public Health, and Center for Evaluating Health Reform, University of Michigan, Ann Arbor, Michigan, Karan R. Chhabra, MD, MScBrigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-2928 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Despite clear-cut evidence that colorectal cancer screening reduces mortality, screening rates are suboptimal in the United States (1). Federal law eliminates consumer cost sharing for multiple methods of colorectal cancer screening, including colonoscopy when done by an in-network provider (2). However, some patients having screening incur considerable out-of-pocket costs because out-of-network bills are not included in federal mandates. "Surprise billing" articles are widespread in the research literature and lay press (3). To date, the frequency of unexpected patient costs for screening colonoscopy have yet to be rigorously quantified.Objective: To estimate the prevalence, amount, and source of out-of-network claims ...References1. Chen C, Stock C, Hoffmeister M, et al. Public health impact of colonoscopy use on colorectal cancer mortality in Germany and the United States. Gastrointest Endosc. 2018;87:213-221.e2. [PMID: 28431951] doi:10.1016/j.gie.2017.04.005 CrossrefMedlineGoogle Scholar2. Kaiser Family Foundation. Preventive services covered by private health plans under the Affordable Care Act. 4 August 2015. Accessed at http://kff.org/health-reform/fact-sheet/preventive-services-covered-by-private-health-plans on 27 April 2020. Google Scholar3. Chhabra KR, Sheetz KH, Nuliyalu U, et al. Out-of-network bills for privately insured patients undergoing elective surgery with in-network primary surgeons and facilities. JAMA. 2020;323:538-547. [PMID: 32044941] doi:10.1001/jama.2019.21463 CrossrefMedlineGoogle Scholar4. Board of Governors of the Federal Reserve System. Report on the economic well-being of U.S. households in 2018 - May 2019. Accessed at http://federalreserve.gov/publications/2019-economic-well-being-of-us-households-in-2018-dealing-with-unexpected-expenses.htm on 24 April 2020. Google Scholar5. Hassan C, Pickhardt PJ, Rex DK. A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening. Clin Gastroenterol Hepatol. 2010;8:865-9, 869.e1-3. [PMID: 20621680] doi:10.1016/j.cgh.2010.05.018 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Virginia, Charlottesville, VirginiaCenter for Value-Based Insurance Design and School of Public Health, University of Michigan, Ann Arbor, MichiganCenter for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan Center for Healthcare Outcomes and Policy, School of Public Health, and Center for Evaluating Health Reform, University of Michigan, Ann Arbor, MichiganBrigham and Women's Hospital, Harvard Medical School, Boston, MassachusettsFinancial Support: By the Division of Gastroenterology at the University of Michigan and by the University of Michigan Institute for Healthcare Policy and Innovation's Policy Sprints Program. Dr. Chhabra receives funding from the Institute for Healthcare Policy and Innovation Clinician Scholars Program and the National Institutes of Health Division of Loan Repayment.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-2928.Reproducible Research Statement: Study protocol: Available from Dr. Chhabra (e-mail, [email protected]harvard.edu). Statistical code: Not available. Data set: Proprietary.Corresponding Author: James M. Scheiman, MD, David Stone Professor, Chief, Division of Gastroenterology and Hepatology, PO Box 800708, Room 2119 MSB, Charlottesville, VA 22908; e-mail, [email protected]edu.This article was published at Annals.org on 13 October 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byRapid Review of "No Surprise" Medical Billing in the United States: Stakeholder Perceptions and ChallengesCosts of colorectal cancer screening with colonoscopy, including post-endoscopy events, among adults with Medicaid insuranceHealthcare costs of colorectal cancer screening and events following colonoscopy among commercially insured average-risk adults in the United StatesSafety Profile of Endoscopist-directed Balanced Propofol Sedation for Procedural SedationPrevalence and Magnitude of Potential Surprise Bills for ChildbirthUnderstanding Surprise Out-of-Network Billing in Hand and Upper Extremity Care March 2021Volume 174, Issue 3Page: 426-428KeywordsBiopsyColonoscopyColorectal cancer screeningCurrent procedural terminologyDisclosureHealth care policyHealth surveysInterquartile rangePathologistsSedation ePublished: 13 October 2020 Issue Published: March 2021 Copyright & PermissionsCopyright © 2020 by American College of Physicians. 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