Many patients receive surprise out-of-network bills for a visit to an in-network hospital's emergency room, according to new research published in The New England Journal of Medicine.
For the study, researchers examined billing data from a large commercial insurer for people under 65 years of age. The data covered 2.2 million ER visits across all 50 states. The researchers agreed not to publish the name of the insurer in exchange for access to the data, according to The New York Times.
The study revealed that patients who went to an in-network hospital's ER received a surprise out-of-network bill 22 percent of the time. Patients face these surprise bills when the physicians who treated them in the ER are not employed by the hospital and are therefore not covered by the hospital's contracts with insurers.
Patients receiving surprise out-of-network bills for ER visits is a widespread problem in the U.S., but people in certain states are far more likely to face this unexpected expense. For example, the rate of surprise billing in McAllen, Texas, is 89 percent, while the rate is nearly zero in Boulder, Colo., according to The New York Times.
Emergency room physicians criticized the study's findings and blamed insurers for the problem. "Most emergency physicians prefer to be 'in-network,' as long as insurance companies pay fairly," said Rebecca Parker, MD, president of the American College of Emergency Physicians. "State and federal policymakers need to ensure that health insurance plans provide fair payment for emergency services and provide adequate rosters of physicians."
However, insurers put a lot of the blame on hospitals, arguing it is their responsibility to ensure all physicians treating patients in their facility are covered by the same insurance contracts as the hospital, according to the report.
Although several states have passed legislation aimed at reducing the problem of surprise out-of-network medical bills, the study's authors argue the issue needs to be addressed form the federal level.
More articles on healthcare finance:
Trinity Health to sell up to $430M in bonds to finance new hospital
8 hospitals receive credit downgrades in past month
Medicare's top 15 costliest drugs in 2015