Out-of-network ED physicians charge patients 150% more than counterparts in network receive, insurer finds

Emergency department physicians who aren't part of a hospital's insurance network, or aren't employed by the hospitals where they work, charge patients an average of 150 percent more than what in-network physicians are paid, a new study by UnitedHealth Group reveals.

For the study, researchers examined physician charges during ED visits for UnitedHealthcare members with 2017 employer coverage. They said they determined the share of ED visits involving out-of-network physicians, as well as the severity-adjusted charges by in-network and out-of-network physicians resulting from those ED visits. They then applied the findings to the annual number of ED visits by all privately insured Americans to determine estimates for healthcare.

Four findings:

1. In 2017, out-of-network emergency physicians increased prices by an estimated $6 billion for privately insured Americans who visited an in-network ED.

2. Out-of-network emergency physicians in 2017 charged $538 (150 percent) on average more per ED visit compared to what in-network physicians were paid ($898 vs. $360).

3. More than 25 percent of the 44 million in-network ED visits studied for 2017 resulted in charges from out-of-network physicians.

4. In 2017, out-of-network emergency physicians charged the most per in-network ED visit, relative to in-network payments, for ear infections, open wounds, flu and bone fractures.

Access UnitedHealth's study findings here.


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