Study Says One in Five ER Patients Hit with Surprise Out-of-Network Bills

Patients who have been admitted in to ER rooms may get surprise out-of-network bills later after they have been treated. These unexpected bills can result from treatment from care providers that the patients may not have realized were out of their insurance network.

According to an article by CNBC, two researchers from the Yale School of Public Health and the Yale School of Management conducted a study that looked into two million emergency room patient visits. Their findings were published in the New England Journal of Medicine.

Study author Zack Cooper, the assistant professor of public health and economics at the Yale School of Public Health says, “Most patients with health coverage go to in-network emergency rooms and rightly expect to be treated by in-network doctors.”

“Our study shows that nearly a quarter of people who visited in-network emergency rooms were exposed to potentially major costs. This is just wrong and we must do better. People should not face financial ruin from medical bills they cannot reasonably avoid.”

The researchers discovered that roughly one in five patients who have been admitted into ERs within their health insurance network were treated by out-of-network providers. This, therefore, resulted in charges that would not be covered by their health insurance or would qualify for significantly less coverage.

According to the study, moreover, the average amount of the surprise out-of-network bills that these patients received was approximately more than $622 dollars. The researchers say these surprise out-of-network bills can range much higher than that. They report that one patient in particular faced a bill that was more than $19,600.

Moreover, an emergency room physician who is out-of-network gets paid nearly 2.7 times what an in-network physician is paid for the exact same services rendered, according to the researchers and CNBC.

The results of the surprise out-of-network bills, according to the study’s authors, are “deeply troubling.” They note that the Federal Reserve has found that most Americans cannot pay $400 dollars in surprise bills unless they were to borrow money or sell assets.

Through their health care plans, patients know that they should be covered from most medical services such as doctor’s visits, hospital stays and tests rendered as long as they are within their health care plan’s network. In exchange for greater access to more patients, physicians who join an insurer’s network agree to accept lower pay rates for services rendered–rates lower than what they would charge for out-of-network patients.

However, when an insured patient accepts care from an out-of-network provider, an insurer my not covert the patient’s bill or might have them cover a larger amount of the out-of-pocket costs than what they might have paid if they have gone to an in-network provider. This can cause problems for emergency room patients. There may be different in- or out-of-network status for both the facility the patient visits and the providers who treat them there.

So even if a patient makes sure they’re visiting an in-network facility, they could end up being treated by an out-of-network provider. The patient may later get hit with surprise out-of-network bills that cover their treatment only partially, or not at all.

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