For the study, researchers pulled online data on preferred provider organization health plans from three of Texas’ largest insurers — Blue Cross Blue Shield of Texas, UnitedHealthcare, and Humana. The researchers also examined two surveys on surprise billing to develop their findings. One was a nationally representative 2016 survey conducted by the Commonwealth Fund and the other was a survey from Consumer Reports that produced Texas-specific data on surprise billing for 2015.
Here are five study findings.
1. CPPP said ER physicians at in-network hospitals bill from 42 percent to 70 percent of their services out-of-network, on average, across the three insurers.
2. The study also found many in-network hospitals do not have a single in-network ER physician available.
3. Across all three insurers, the share of out-of-network billing by ER physicians was at least 2.5 times greater than the shares by the other hospital-based physician types, such as neonatologists, pathologists, radiologists and anesthesiologists, according to the study.
4. Hospitals are also more likely to lack an in-network ER physicians than other hospital-based physician types, the study found.
5. Still, the study did identify 23 Texas hospital ERs where surprise billing appears rare. Those 23 hospitals, which are in-network with all three insurers, had fewer than 10 percent of ER physician charges billed as out-of-network.
See the full study here.
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