Many Receive Surprisingly High Bills After In-Network ER Visits

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Although a hospital may be in an insurance network, the treating physician may not be.
Although a hospital may be in an insurance network, the treating physician may not be.

HealthDay News — Many patients visiting an in-network US emergency department end up with major unexpected costs, according to a perspective piece published in the Nov. 17 issue of the New England Journal of Medicine.

Yale University researchers looked at 2.2 million emergency department visits made by patients younger than 65 nationwide between early 2014 and late 2015. Nearly one-quarter of the patients who went to emergency departments within their health insurance networks were treated by an out-of-network doctor and ended up with unexpected expenses.

According to the findings, out-of-network emergency medicine doctors charged up to 798% of Medicare rates, while in-network emergency physicians were paid around 297% of Medicare rates. Patients were presented with an average bill of $622.55, and potentially much more, if their insurer only covered in-network rates, the researchers reported.

"Most patients with health coverage go to in-network emergency rooms and rightly expect to be treated by in-network doctors," study coauthor Zack Cooper, PhD, an assistant professor of public health and economics at the Yale School of Public Health in New Haven, Connecticut, said in a Yale news release. "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."

Reference

Cooper Z, Morton FS. Out-of-network emergency-physician bills — An unwelcome surprise. NEJM. 2016; 375:1915-1918. doi:10.1056/NEJMp1608571.

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