Doctors and other health care providers are billing unsuspecting patients ever increasing amounts for out-of-network care. A new report from the Health Care Cost Institute reveals which doctors and other health care providers are more likely to charge insured patients for out-of-network care, sending out “surprise medical bills.” Congress agrees surprise medical billing is a problem, but it can’t seem to agree on how to address it.
In many cases, surprise medical bills are for thousands of dollars, and patients have no control over them. Too often, patients end up in medical debt. Fortunately, it is less of a problem for people with Medicare because providers are limited in what they can charge people with Medicare.
Pathologists, specialists who study tissues and fluids to help diagnose medical conditions, are the health care providers who most frequently bill for out-of-network care. More than one in three pathologists billed hospitalized patients for out-of-network care more than 90 percent of the time. And about one in five pathologists billed patients for outpatient visits out-of-network more than 90 percent of the time.
Much like pathologists, a large share of emergency care providers bill patients for out-of-network inpatient care. About 44 percent of providers in both specialties. Emergency care doctors do not send out surprise medical bills as frequently as pathologists. But, when they do bill for out-of-network care, the charges can be sky-high.
Members of Congress on both sides of the aisle support legislation to address surprise medical bills. But, they have not been able to reach agreement on a solution. The simplest solution would be for the government to limit what health care providers can charge for their services out of network. But, hospitals and private-equity firms, which sometimes own pathology and emergency care medicine practices, are arguing for arbitration.
Recent Congressional legislation appropriating stimulus money for hospitals in response to the coronavirus pandemic specifically forbids hospitals from sending surprise bills to patients receiving COVID-19 care. Still, stories abound of patients receiving surprise bills for COVID-19 care, including one person in Denver who received a bill for $140,000.
HCCI researchers found that in addition to pathologists and emergency medicine providers, many other types of specialists bill patients for out-of-network care, though at different frequencies. The proportion of providers with at least one out-of-network claim for inpatient visits ran the gamut from 18% for cardiology to 44% for emergency medicine. For outpatient visits, the share of providers with at least one out-of-network claim ranged from 15% for behavioral health to 49% for emergency medicine.
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