Health & Science

Emergency Room Patients Often Hit With Surprise Medical Bills

A sudden injury or illness that sends you to an emergency room can be traumatic enough. But the bills you might get afterward — so-called “out-of-network” charges — can be an added stress.

FILE – In this Wednesday, May 1, 2013, file photo, a lab technician draws blood from a patient at a health center, in Phoenix.

Out-of-network medical bills happen when insurers and doctors fight over prices, and they both send bills to patients who often unknowingly received care from a doctor who’s not on their insurance plan. A new report from the Center for Public Policy Priorities finds that emergency medical care often results in surprise medical billing. The center’s Stacey Pogue says their analysis shows two things.

“One, is we found it is routine that people go into a hospital in an emergency, they’re in an in-network hospital, but they’re treated by doctors who are out of network. So they can get these big surprise bills,” Pogue says.

The other thing is there’s a staggering share of hospitals who don’t have even a single in-network emergency room doctor for one of the larger insurers that the hospital does accept, and that guarantees out-of-network emergency treatment. Kim Carrier from New Caney had that experience when he had a skin infection on his neck, even when he asked up front if there’d be any additional charges.

“And I asked the receptionist, ‘if I let you guys treat me, am I going to get a surprise monster bill?’ And she says, ‘oh, you’ve got good insurance. You’re just fine.’ And I get a $1,100 bill. I said ‘why am I being asked to pay 1100 bucks?’ ‘Your insurance paid the doctor’s bill, but this is for the facility,'” Carrier says. 

Another patient, Rick Stephenson from Friendswood, went to an in-network emergency room with a deep cut on his finger, but it turns out the doctor was out of network. So a bill arrived in the mail.

“Maybe what they’re saying is what you need to do before you go anywhere, you have to call around and make sure that in an in-network facility to make sure that all the personnel are in-network, when you’re in a state of emergency. Is that what they’re expecting, you know, the individual do,” Stephenson asks.

The report says there are more than 300 hospitals in Texas where the hospital itself is in-network, but there’s not a single in-network ER doctor available with one of the three large insurers examined in this study — Humana, Blue Cross and United Healthcare. 

“Doctors point their fingers at the insurance companies and say ‘it’s your fault and you need to fix it,’ and insurance companies do the same. They point back to doctors and say ‘no, it’s your fault. You need to fix it.’ And they can each come up with great solutions that cost the other one money. But they’re not sitting down at the table and trying to work towards a comprehensive solution that puts patients first,” Pogue says. 

Years ago, Pogue says the Texas Legislature developed a mediation system for surprise bills.

“But it really just means that the doctor’s office and the insurance company have to pick up the phone and see if they can’t work out their pricing dispute. When a patient can get into the system it works. It’s a tiny, tiny fraction of patients who’ve managed to get through the door because it’s just too hard to trigger that mediation and make it happen,” Pogue says. 

Other states have adopted the mediation model, but with improvements.

“They use mediation, but they don’t make the patients go to mediation. They tell the doctors and insurance companies ‘if you guys can’t agree on prices, you go to mediation, but don’t send the surprise bill to the patient,” Pogue says.  

Pogue says the problem has not been solved in Texas because three very powerful parties — doctors, insurance companies and hospitals — keep pointing fingers at each other instead of trying to help patients. State Sen. Kelly Hancock is introducing Senate Bill 507 this session to make more medical bills eligible for mediation.

More Information:

Surprise medical billing website

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