Patients who make sure to visit in-network emergency departments can still end up facing considerable out-of-pocket costs for out-of-network physicians, according to a report from The New York Times.
The Times offers the example of pediatrician Michael Schwartz, MD, whose daughter had to visit an ED in the suburbs of Philadelphia in 2010 because of a reaction to medication. The facility she visited — Bryn Mawr (Pa.) Hospital — was in-network for Dr. Schwartz's insurer, Capital Blue Cross. But the physicians who provided cardiac monitoring services to his daughter were out-of-network, resulting in an unexpected $2,000 bill, according to the report.
Patients don't get to choose the physicians they see in the ED, and encounters with out-of-network providers at in-network hospitals are leaving more and more people facing significant costs for services their insurers don't cover, according to the Times. It's becoming common for EDs to employ physicians who are private contractors and may be out-of-network for major insurers or not accept any insurance at all. For instance, data provided by Texas health insurers responding to a request from state legislators revealed that as many as half of the hospitals that contracted with the state's biggest insurers (UnitedHealthcare, Blue Cross Blue Shield and Humana) didn't have any in-network emergency physicians, according to the report.
Jeffrey Bettinger, MD, chairman of the reimbursement committee of the American College of Emergency Physicians, told the Times out-of-network physicians in EDs are uncommon. He also said situations where hospitals use out-of-network clinicians usually arise because insurers won't reimburse the physicians at a reasonable rate, compared to what they pay hospitals.
The report follows an article the Times published last week on patients who are hit with unanticipated hospital charges due to the increasing practice of "drive-by doctoring" — calling in consultants and other healthcare workers whose presence may not be needed and who may be out-of-network, resulting in sizable additional fees. The issue has led some to question whether hospitals and health systems are calling in unneeded consultants and assistants so they can inflate bills to compensate for reimbursement rate cuts.
More articles on healthcare costs:
Unexpected out-of-network charges frustrate patients
Cigna, Blue Shield of California sued over narrow networks
Will bundled payments kill innovation?