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“5 Doctors Most Likely to Stick You With Surprise Medical Bills” 3 5/5 (1)

Insurance often won’t cover the expenses, but there are ways to avoid paying excessive charges.

It seems so unfair. You’re most likely to get hit with a big medical expense your insurance won’t cover when you’re most powerless to do anything to avoid it.

These surprise medical bills usually result from emergency situations or when your doctor uses out-of-network specialists without telling you, according to a national study by Johns Hopkins University.

The new study, which examined the problem of surprise medical bills, was published today in the Journal of the American Medical Association.

“These are not doctors you typically choose,” says Gerard Anderson, the study’s senior author and a professor at the Johns Hopkins Bloomberg School of Health.

As a result, you usually don’t know beforehand whether they take your insurance. Anderson says people are shocked when they get a bill for many hundreds or thousands of dollars from out-of-network doctors they may never have met, sometimes months after being treated.

“This is happening all the time,” he says.

The study of more than 400,000 doctors across the U.S. ranks the difference between how much Medicare reimburses for treatments the doctors perform and what they charge out-of-network patients covered by other types of insurance—or who aren’t covered at all.

Medicare fee schedules were used as the benchmark because insurers typically use them as a starting-off point when they calculate how much they will reimburse patients for treatments they receive out of network.

The average physician charges about 2½ times what Medicare pays, but the highest markups were for doctors you usually don’t select for yourself—often because it’s an emergency or it’s a specialist your in-network doctors refers you to.

Who Charges the Most—and Least

The study looked at physician charges across 54 specialties. It found that the average anesthesiologist, radiologist, emergency physician, pathologist, and neurosurgeon charge for their services at least four times what Medicare reimburses. In anesthesiology, the average charge was almost six times as high as what Medicare pays.

On the positive side, doctors with the lowest markups are the ones people see most often. General practice doctors, psychiatrists, allergists, immunologists, dermatologists, and family practitioners charge less than twice the Medicare rates.

The researchers also found regional differences. Doctors in Alaska and Wisconsin, for example, mark up prices at almost twice the rate of doctors in Hawaii and Michigan, on average.

See Also: “How to Avoid a Surprise Medical Bill”

(Information from:

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