Surprise Emergency Room Bills Continue to Frustrate Patients

As if it’s not scary enough to go to an emergency room for an unforeseen injury or accident, add surprise emergency room bills to the stress.

A study done by Yale University found that patients who seek emergency treatment at an in-network facility have nearly a 1-in-4 chance that they will be treated by an out-of-network emergency room doctor. If you’ve never experienced this, you’re probably wondering, how can that even happen?

If a facility is in-network with an insurance company, that means a contract exists between the hospital and the insurance company. If a doctor is not employed directly by the hospital, the doctor is not obligated by that contract.

Most emergency room staff, including doctors, are contracted through outside medical staffing agencies. These independent contractor-type doctors need to have their own contract with an insurance company in order for the rules of the insurance company to be effective.

Many patients assume that if they are treated at an emergency room of an in-network hospital, the doctors and staff who treat them must be in-network as well. If the patient is unknowingly treated by an out-of-network physician, they may receive surprise emergency room bills days or weeks after returning home and the diagnostic codes for the care received have been processed by the providers and the insurance company.

Even if the surprise emergency room bills are not for the entire amount of the provided care, they can still equal hundreds or thousands of dollars. An insurance company might provide minimal coverage for an out-of-network provider, perhaps equal to $3,000 of a $20,000 bill. When the patient receives a bill for $17,000 from the out-of-network doctor’s office, the surprise emergency room bill is also known as a balance bill because the patient is responsible for the balance due.

Surprise Emergency Room Bills Ignite Blame Game

Some doctors who do not contract with insurance companies say they can’t afford to do so. They accuse insurance companies of trying to contract for rates that are below what even Medicare or Medicaid would pay for the professional services.

Insurance companies point the finger back at non-contracted doctors, accusing them of not agreeing to contracted rates because they can soak the patients for the entire amount after the care has been received. In such cases, the surprise emergency room bills are no surprise to the doctors who aren’t in network with any insurance company.

Even planned surgeries can produce surprise medical bills. Anesthesiologists often are independent contractors who must have their own contracts with insurance companies in order to be considered an in-network provider. A surgery performed at an in-network facility by an in-network doctor might result in an unexpected medical bill from an out-of-network anesthesiologist.

One family who had a $3,000 anesthesiologist bill decided to make sure the next anesthesiologist was on the family’s health insurance when their daughter needed a second surgery. When asked if he was covered by Aetna health insurance, the anesthesiologist said he was not accepting that plan.

The father insisted the anesthesiologist be on their medical plan, so the original one switched surgical assignments with an anesthesiologist who said he did accept Aetna health insurance.

Because the surgery was performed the first week of January 2016, the anesthesiologist didn’t realize his office dropped Aetna from their contracted plans effective Dec. 31, 2015. The family received a second large unexpected bill.

Join a Free Surprise Medical Bill Class Action Lawsuit Investigation

If you were hit with a surprise medical bill from an out-of-network doctor at an in-network hospital, you may be entitled to compensation.

Learn More