Surprise Medical Bills from EmCare: Out of Network Doctors at In Network Hospitals

EmCare, a subsidiary of Envision, provides emergency room hospital staff to medical  facilities. Consumer advocates say EmCare services have allegedly led to patients receiving surprise medical bills.

Surprise medical bills are also known as balance bills, because the patient is billed for the difference between the amount the insurance company pays and the amount the provider charges. Patients who seek emergency room care at an in-network hospital often receive unexpected balance bills after they have been treated by out-of-network providers.

UnitedHealthcare has decided to end a contract with EmCare‘s parent company Envision Healthcare over allegations of “egregious billing practices.” UnitedHealthcare alleges that Envision charged fees that were generally 975 percent higher than fees charged by Medicare.

In a court filing, UnitedHealthcare said, “In addition, disturbingly, Envision charges nearly double what UHC sees from hospitals who manage their own ERs.”

UnitedHealthcare noticed that after Envision merged with Sheridan Healthcare in 2016, Envision dramatically increased its fees without notifying UnitedHealthcare of the changes, which allegedly led to “millions of dollars of overpayments.”

Envision’s EmCare faced criticism for its part in sending surprise medical bills to unsuspecting patients. One healthcare executive called EmCare’s surprise medical bills “a real fiasco.”

EmCare and Surprise Medical Bills

EmCare reached a $29.6 million settlement with the Department of Justice in December when the company faced allegations it convinced a hospital chain to admit patients instead of treating them appropriately as outpatients. That hospital chain is now out of business.

U.S. Senator Claire McCaskill, D-Mo., was demanding answers from EmCare because emergency room visits went from under $500 for a hospital doctor’s care to upwards of $1,600 for an EmCare doctor’s care.

McCaskill released a statement saying, “Emergency room visits can be far too expensive already – and if EmCare is gaming the system just to up their profits, that needs to be thoroughly investigated. I’m committed to protecting patients in Missouri and across the country by getting to the bottom of what’s going on with EmCare’s billing.”

One report estimates a hospital’s costs tripled when EmCare assumed the staffing and billing responsibilities.

Patients across the country are at risk of receiving surprise medical bills, whether from EmCare or another care provider. One study looked a snapshot of 300 Texas hospital emergency rooms and determined that even though the hospitals were in-network for a particular insurer, not one of the emergency room physicians on duty was in-network.

A surprise medical bills class action lawsuit was filed against EmCare and EDS-1 Practices of California in 2017. The lead plaintiff alleges the hospital emergency room she visited was in-network with her health insurance and that no one in admitting warned her that the doctors were not under the same insurance plan.

She says she discovered the EmCare doctor that treated her was out-of-network and that as a result, she owed $4,000. Her lawsuit contends that figure is more than four times the average in-network fees.

If you have visited an in-network hospital emergency room and have been faced with EmCare or another company’s surprise medical bills, you could be eligible to participate in this investigation.

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.

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