The Reason behind “Surprise” Medical Bills

By ACEP, Special for  USDR

Health insurance companies are ignoring a real solution to “surprise” medical bills and misleading their customers and the public when they blame physicians, according to Dr. Rebecca Parker, president of the American College of Emergency Physicians (ACEP).  Dr. Parker gave the following statement in response to media coverage generated by a recent letter published in the Journal of the American Medical  Association:

“Several recent news reports present inaccurate, one-sided perspectives of the “surprise billing” issue, exaggerating the severity of the problem and placing the blame on physicians, when in fact it is the insurance companies who are gaming the system, and taking blatant advantage of their customers, who are our patients.   The letter in JAMA focused on all physicians, but insurance companies need to shoulder the blame for the out-of-network situation in emergency medicine, because they are narrowing their networks of medical providers, making it more likely that patients will be in out-of-network situations, and they continue to pay less.  The study also defines any charges above Medicare as excessive, which is not true.  Historically, they have sought to deny payment for emergency patients as much as  possible.

“Emergency physicians have proposed a recently passed law in Connecticut as the solution, which requires the use of an independent and transparent charge database.   We are urging policymakers at the state level to implement this solution, which will take patients out of the middle.  Emergency physicians and other physicians who provide on-call services in the emergency department would be in-network if insurance companies paid  fairly.

“No one chooses when they will need emergency care and should not be punished financially for having emergencies or discouraged from seeking medical attention when they are sick or injured.  But significant co-pays and high deductibles effectively do exactly that.  This is unacceptable and our patients deserve  better.

“Health insurance companies have a history of data manipulation and not paying for emergency care.  There have been significant reductions in insurance payments for emergency care, as much as 70 percent.   They have taken gross advantage of patients and emergency medical providers since the ACA, arbitrarily slashing payments to physicians.  The EMTALA mandate gives the insurance industry the upper hand and can exploit the situation, because the doctors have to see all patients, regardless of insurance status or ability to  pay.

“An analysis of out-of-network emergency billing in the state of Florida found it to be rare.  According to the data, which represented 10 percent of emergency visits in Florida, the average patient payment was just $49 – hardly the thousands of dollars that the insurance companies would like you to  believe.

Dr. Parker adds that emergency physicians are asking the insurance companies to provide fair coverage for their beneficiaries and be transparent about how they calculate payments.  State and federal lawmakers also need to ensure that health insurance plans provide adequate rosters of physicians and fair payment for emergency  services.

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government  agencies.

SOURCE American College of Emergency Physicians  (ACEP)

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