Costs Can Go Up Fast When ER Is in Network but the Doctors Are Not

Even the most basic visits with emergency room physicians and other doctors called in to consult are increasingly leaving patients with hefty bills: More and more, doctors who work in emergency rooms are private contractors who are out of network or do not accept any insurance plans.

Patients have no choice about which physician they see when they go to an emergency room, even if they have the presence of mind to visit a hospital that is in their insurance network. In the piles of forms that patients sign in those chaotic first moments is often an acknowledgment that they understand some providers may be out of network.

But even the most basic visits with emergency room physicians and other doctors called in to consult are increasingly leaving patients with hefty bills: More and more, doctors who work in emergency rooms are private contractors who are out of network or do not accept any insurance plans.

When legislators in Texas demanded some data from insurers last year, they learned that up to half of the hospitals that participated with UnitedHealthcare, Humana, and Blue Cross-Blue Shield—Texas’s 3 biggest insurers—had no in-network emergency room doctors. Out-of-network payments to emergency room physicians accounted for 40% to 70% of the money spent on emergency care at in-network hospitals, researchers with the Center for Public Policy Priorities in Austin found.

Report on The New York Times: http://nyti.ms/1rvKMQC