The insurer then has 45 days to handle a provider's claim and offer “a reasonable reimbursement” for the unanticipated out-of-network care – which a provider can decline and then either negotiate or arbitrate a final binding decision – with arbitration costs evenly split between provider and carrier.

As a 2017 report in JAMA by Johns Hopkins researchers noted, most patients do not actually choose doctors with the highest markups, like anesthesiologists, emergency medicine doctors, and diagnostic radiologists – allowing them no opportunity to anticipate how high their bills will be.


"The doctors with the highest markups are often the ones that patients don't actually choose," senior author Gerard F. Anderson, Ph.D., a professor in the Department of Health Policy and Management at the Bloomberg School, said at the time. "Many people are shocked two weeks or two months later when they get a bill from a doctor they didn't really meet and no one told them what the exam would cost, and later they discover the price is outrageous. But this is happening all the time."

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