Surprise! Out-of-Network Billing for Emergency Care in the United States

Authored by journals.uchicago.edu and submitted by smurfyjenkins

In the United States, hospitals and physicians independently negotiate contracts with insurers. Therefore, a privately insured individual can be treated at an in-network hospital’s emergency department but receive a large unexpected bill from an out-of-network emergency physician working at that facility. Because patients do not choose their emergency physician, emergency physicians can remain out of network and charge high prices without losing patient volume. We illustrate that this strong outside option improves physicians’ bargaining power with insurers. We conclude by analyzing New York’s efforts to address out-of-network billing through binding arbitration between physicians and insurers over out-of-network payments. This intervention reduced out-of-network billing by 12.8 percentage points (88%).

ferretnoise on August 15th, 2020 at 20:34 UTC »

Just a clarification: This is not usually the choice of the ER doctor themselves. It is a decision made by the agencies or hospital systems that hire us, and we usually have no idea what networks we are "in" and "out" of with some notable exceptions. We rarely have control over this sort of arrangement.

Source: Am ER Doctor.

rhineStoneCoder on August 15th, 2020 at 19:15 UTC »

Reminds me of my one and only surgical procedure. Doctor, anesthesiologist, were all in-network, but the facility was out-of-network. So everything was covered except the $7K facility bill.

Gemmabeta on August 15th, 2020 at 16:52 UTC »

Medicine is not the free market.

Who price-shops for their hospital (of which there is probably only 1 in a 100 mile radius) and their ER attending/nurses when dying of a heart attack?