Patients Face Potential Surprise Emergency Room Bills

Patients across the country are facing surprise emergency room bills, often after visiting for life saving medical procedures. Often during emergency medical situations, patients are forced to go to emergency rooms that may or may not by in their insurance network, which may produce surprise emergency room bills.

A recent study by Yale School of Public Health and Yale School of Management examines the correlation between emergency room visits and surprise emergency room bills.

The study looked at over two million emergency room visits in different hospitals. Researchers found over one in five patients who had visited emergency rooms within their health insurance networks had still experienced surprise emergency room bills.

This was because the patients were reportedly treated by “out of network” providers, which made the patients vulnerable to additional charges not covered by their health insurance. The study found that surprise emergency room bills can average over $622, unless the insurance plan agrees to partially or fully cover it.

However, these medical bills can run significantly higher, as exemplified by one patient who faced a potential bill of over $19,600. In addition, the study had found that out of network emergency doctors are paid almost 2.7 times the amount that in-network doctors were paid for the same services.

The authors also noted that Federal Reserve had found that nearly half of all Americans were unable to afford to pay unexpected bill as low as $400. Researchers commented that patients should not have to face financial ruin from medical expenses they can’t avoid incurring.

Overview of Surprise Emergency Room Bills

While health insurance plans cover the cost of most medical services, coverage is often reduced if patients use an out of network physician. Health insurance plans often have a list of medical care providers within the plan’s network who will generally agree to provide lower charges under arrangements with the insurance companies.

So if patients go to an out of network provider, there is a good chance the insurance company will not provide partial or any coverage of the medical bills. The New England Journal of Medicine published a recent article that noted hospitals generally contract with emergency room doctors who may have their own arrangements with insurance companies.

This causes doctors within the same hospital to be contracted with different insurance companies, so that an emergency room patient may bee seen by a mix of in-network and out-of-network providers in a single visit. This results in the surprise emergency room bills. This study found this occurrence is fairly common, with authors looking at claims data from a large insurance company that covers tens of millions of policyholders.

The authors examined 2.2 million emergency room visit claims from patients under the age of 65 and submitted in 2014 and 2015 from all 50 states, and found that 22% of visits occurred in hospitals within network but treatment was given by out of network physicians.

The study concluded that patients should be given stronger disclosures about potential surprise emergency room bills, and that stronger legal protections are needed. Patients who received the surprise emergency room bills may also be able to file legal action to combat these actions.

Join a Free Surprise Medical Bills Class Action Lawsuit Investigation

If you received a bill from an out-of-network doctor after being treated at an in-network hospital, you may qualify to file a surprise medical bill lawsuit or class action lawsuit. It’s absolutely free to take part in an initial consultation, so act now!

Get a Free Case Evaluation Now