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A ‘surprise’ medical bill often occurs when a patient has a hospital procedure or visits an emergency room and is treated by a provider they didn’t choose and who is not part of the patient’s health insurance network. These providers can include assistant surgeons in the operating room, emergency room doctors and anesthesiologists.
If you think you haven’t been affected, check this out: A recent study published in the American Journal of Managed Care suggests that everyone with private health insurance is paying higher premiums today because the practice of surprise billing exists. The authors argue that fixing surprise billing won’t just help the patients being billed; it offers the potential to lower health insurance premiums for all of us.
When patients have the opportunity to make an informed choice by selecting a doctor or provider in their insurance network, the associated health care cost decreases. However, this choice doesn’t always exist.
In an emergency, patients seldom choose which ambulance company arrives on scene or which physicians treat them in the emergency room. About 1 in 5 insured patients treated in an emergency room at a hospital within their insurance network are still seen by an out-of-network physician.
There’s also no incentive for these types of health care providers to join networks to get patients, because the nature of their work assures a steady stream of business. This gives providers bargaining leverage when negotiating with insurers and allows them to negotiate higher prices.
The result: The study found radiologists were paid roughly twice as much by private insurers as Medicare pays on average for in-network services. Emergency room physicians receive in-network payments triple what Medicare reimburses.
Do you think lawmakers should pass federal policies to address how surprise billing affects overall health care costs for everyone? Share your thoughts.