Some insured patients in the U.S. are facing a nightmare. A new study published in the New England Journal of Medicine finds that, across the country, 22 percent of people visiting in-network emergency rooms have to deal with bills from out-of-network doctors. Two economists from Yale are now calling for states to end a practice that allows some doctors to surprise patients with large medical bills after visits to a hospital emergency room.
'Surprise' Bill Gets Charged When Patients Get Treatment From Doctors Not Part Of The Insurance Network
Based on reports, the bill shows up when patients get treatment at a hospital that's in the patient's insurance network but the hospital has hired doctors who are independent contractors who choose not to be part of that network. We all assume that when you have an in-network hospital that people working (there) also are in network, and that's not the case," Yale assistant professor and one of authors of the research, Zack Cooper, said.
Cooper and co-researcher analyzed insurance claims for more than 2 million ER visits around the country and found out roughly 2 of 10 in-network visits involved a doctor not in the patient's insurance network.
The Results Are Troubling, Researchers Say
In an interview, Cooper said: "Patients are not thinking of the bill when they need to get care and they get walloped later with a bill from a physician they didn't know, couldn't choose and couldn't avoid. It's roughly analogous to going out to dinner, having a decent meal, paying the bill, and eight weeks later getting a $10,000 bill from the guy who served the bread. And they threaten to send us to collection if we don't pay."
Bundled Reimbursement Set-Ups Benefit Insurance Companies, Not The Patients
The authors of this study said that the best solution would be for "states to require hospitals to sell a bundled ED (emergency department) care package that includes both facility and professional fees."
Dr. Jim Augustine, an ACEP expert on out-of-network issues, said billing used to be a package deal until the federal government demanded separate billing in the 1970s and 1980s. "Insurance companies would like to have bundled reimbursement setups because it's advantageous for their contracting. It's not advantageous for the people who provide care for them," Augustine said.