With 1 in 5 ER patients affected, it’s time to stop ‘surprise’ medical bills

emergency-services_overviewYour kid takes a tumble and breaks an arm at a sleep-over. Your spouse, on a business trip, suffers sudden chest pain and shortness of breath. You’re in beach slippers and step by accident on a shard of glass stuck in the sand. Now, you’ve got oodles of time to check your insurance policy to  find the nearest emergency room that’s covered by your insurer, right? And you’ll be asking every physician who treats you if they’re part of your network, right?  Well, no, nobody does that.

So brace yourself: a new study says that 1 in 5 Americans gets whacked after their ER visit with added charges not covered by insurers for out-of-network care. The surprise medical bills averaged $900 but ran as much as $19,000.

“To put it in very, very blunt terms: This is the health equivalent of a carjacking,” Zack Cooper, an assistant professor of health policy and economics at Yale University, commented to the New York Times. He is a co-author of the paper on surprise medical bills, published in the peer-reviewed New England Journal of Medicine.

Cooper and other critics condemn insurers for unfairly failing to cover patients throughout bona fide medical emergencies. They point out that insurers already demand that customers research extensively to ensure they get treated only in insurer networks. Insurers insist on this practice because they can better control costs, negotiating in advance with specified caregivers in their networks over prices and services, they say.  But, in emergencies, it’s unreasonable to expect similar patient diligence, critics say.

ER doctors have criticized this and other studies, arguing that, after the typical back-and-forth among providers and insurers, patients don’t get stuck with much of a tab for out-of-network care. ER docs and insurers argue a lot, with the insurers criticizing the physicians for declining to be in many networks, while the MDs say many don’t pay them enough to join.

I say bah-humbug to the lot. I’ve written about how California, New York, and Florida are among many states that have stepped in to curb abusive surprise medical bills. The folks at Consumer Reports are leading a charge to end them. Research has shown that ER treatment is among the most costly, and all of us can try to avoid seeking routine care there. Although studies show that retail urgent care clinics aren’t doing exactly that, as many would hope—consumers are actually tapping them for more services, not just reducing emergency assistance—buried in the data also is the finding that 20 percent of ER visits involved procedures that could have been better
handled elsewhere
.

Cooper, for one, says that Congress could and should take a clue from the states and enact national legislation to halt ER surprise bills. I agree.

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