Surprise Emergency Room Bills Occur when ER Doctor is Out of Network

Patients who receive treatment at an in-network hospital are at risk for receiving surprise emergency room bills.

A study found that one out of every five patients who visits an in-network emergency room was treated by an out-of-network doctor. The patients didn’t know at the time that they would end up responsible for that doctor’s charges that were not covered by their insurance.

According to CNBC, Zack Cooper and Fiona Scott Morton wrote their findings in the New England Journal of Medicine after they looked at data analyzing more than two million emergency room visits. The researchers are from the Yale School of Public Health and the Yale School of Management.

The average out-of-network bill was more than $622, but one patient received surprise emergency room bills totaling nearly $20,000.

The issue is complicated by the fact that out-of-network emergency room physicians received almost 2.7 times the fees earned by in-network doctors who performed the same care. Even though a hospital is in-network, the emergency room physicians have contracts with insurance companies that are independent of the hospitals’ contracts with insurance companies.

Surprise Emergency Room Bills Difficult to Control

The researchers discovered 22 percent of the visits they studied at in-network hospitals included treatment by doctors who were out-of-network.

Certain geographic areas tended to have more surprise emergency room bills than others. The researchers wrote, “In McAllen, Texas and St. Petersburg, Florida, surprise billing rates were 89 percent and 62 percent respectively. In contrast, in Boulder, Colorado and South Bend, Indiana, the surprise billing rate was near zero, suggesting that surprise billing is a solvable problem.”

States such as New York now have laws that prohibit out-of-network physicians from balance billing patients who have sought treatment at a facility within their insurance company’s network. Patients who do receive surprise emergency room bills in New York have to complete several pages of forms in order to settle the amount in question.

In many cases, the laws that make sure the patient is not held accountable to pay the out-of-network doctor bill actually require the insurer to pay that bill.

“Although they limit additional costs for consumers, such laws create perverse incentives for providers to avoid joining networks because the insurer must still pay the billed rate. Insurers will ultimately pass these higher costs on to consumers in the form of higher premiums,” say the researchers in their article.

If you have received treatment by an in-network hospital and have received surprise emergency room bills because the doctor who treated you was out-of-network, you could have a legal claim. You could benefit by speaking with a lawyer regarding your legal options for compensation.

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!

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