Patients often face surprise bills after receiving treatment at an in-network hospital where they were cared for by an out-of-network emergency physician, radiologist, anesthesiologist or other healthcare specialist. Consumer advocates say the prevalence of narrow networks has made surprise bills more common.
The American College of Emergency Physicians filed a lawsuit against HHS in May, alleging an Affordable Care Act provision does not ensure reasonable payment to physicians for out-of-network emergency services. The association says insurers have reduced payments to ER physicians up to 70 percent in recent years. Ontario, Calif.-based Prime Healthcare Services sued six insurers last month for allegedly using an incorrect system to set out-of-network rates, The Wall Street Journal reported.
However, insurers argue physicians are rejecting more in-network rates and charging higher, out-of-network rates, according to the report.
About 75 percent of plans sold through the federal marketplace this year extend no out-of-network coverage save for emergencies, according to The Wall Street Journal. Plan members can face unlimited costs, as out-of-pocket bills typically do not have out-of-pocket maximums.
Almost two dozen states passed or are considering legislation that would protect consumers from unexpected out-of-network medical costs.
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