Importance Privately insured patients who receive care from in-network physicians may
receive unexpected out-of-network bills (“surprise bills”) from out-of-network clinicians they
did not choose. In elective surgery, this can occur if patients choose in-network surgeons
and hospitals but receive out-of-network bills from other involved clinicians. Objective To
evaluate out-of-network billing across common elective operations performed with in-
network primary surgeons and facilities. Design, Setting, and Participants Retrospective …

Editorial Comment: Unexpected or “surprise” medical billing refers to the scenario where a
patient receives care from facilities or providers within the patient's insurance network but
receives separate bills from other providers who are out-of-network. These bills are often
associated with higher out-ofpocket obligations in the form of some combination of balance
billing and higher cost sharing through co-pays, deductibles and coinsurance. This
interesting study evaluated the prevalence of surprise billing among patients undergoing …