Say you break your leg. Luckily, you’ve insurance, so you head to an emergency room (ER) that is in your insurance network — and you consider, at least when it comes to your medical bill, you are all good.
But a new study out of Yale University finds you might not be.
“This is one of the scary parts of American medicine,” claimed Zack Cooper, an assistant professor of public health and economics at Yale University. “Hospitals and physicians independently discuss with insurers over network participation. So it is possible to have a physician inside an in-network hospital who, himself or herself, is out of network.”
In accordance with the U.S. Centers for Disease Control and Prevention, about 40% of the U.S. population visits an emergency department each year. To learn more, team of Cooper obtained data from a major commercial insurer, studying almost 9 million ER visits between 2011 and 2015.
In his paper issued by the National Bureau of Economic Research, he reported surprise out-of-network billing is not happening at all hospitals – it is merely done a lot by a relatively narrow group of providers, about 10 to 15 percent.
“A lot of those hospitals tend to be for-profit,” Cooper claimed. “And, in several instances, have emergency room handled by this one single company: EmCare.”
EmCare, a physician outsourcing company, has disputed the methodology of study, but in a statement, applauded out-of-network billing is a “structural issue” in health care.
“The study suitably identifies out-of-network reimbursement as a source of dissatisfaction for all payors, providers and sufferers in our current healthcare system,” stated Kim Warth, communications director for EmCare’s parent company, in an e-mail. “We agree with the implied suggestion — which is to advance a shared goal to reengineer the current system in a positive way.”
Cooper claimed that he hopes his work inspires legislators to follow the lead of states like New York, which in the year of 2014 passed a law designed to protect sufferers who get emergency room care from surprise out-of-network bills.
He also needs to examine out-of-network surprise billing in other medical specialties – such as neonatology, anesthesiology, and radiology.
“There are many really complicated issued in health care that can’t be solved,” Cooper stated. “This is one of these rare problems that are incredibly devastating, that we can fix.”
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