One in every four patients still receive an unexpectedly high bill after a trip to an in-network emergency room, a new Yale study revealed.
That's a whopping 22 percent of patients who visited emergency rooms within their health insurance networks but were treated by an out-of-network doctor and still received major expenses, researchers said.
'Surprise' Bills
The team from Yale University looked at 2.2 million ER visits made by patients aged 65 years old and lower across the United States from January 2014 to September 2015.
Their findings reveal that out-of-network ER doctors charge up to 800 percent of Medicare rates, while in-network ER doctors receive 300 percent of Medicare rates.
This meant that most patients were presented with an average bill of $622 and much more if insurers only covered in-network rates, experts said.
Unfortunately, about 47 percent of Americans would not find it easy to pay such an unexpected expensive medical bill without selling assets or incurring credit card debt, the U.S. Federal Reserve said.
Zack Cooper, co-author of the Yale study, said most patients go on an ER visit expecting to be treated by an in-network physician, but this is not what happens.
Because doctors do not sign contracts with insurance companies connected to the hospital they work at, most patients who visit a hospital in their insurance network can still be treated by an out-of-network physician.
"This is just wrong and we must do better," said Cooper. "People should not face financial ruin from medical bills they cannot reasonably avoid."
The Case Of Tracey And Inga Davis
Such is the case of Tracey and Inga Davis. In August, Tracey broke his ankle and was taken to the ER. His wife Inga made sure the hospital was within their health insurance network and that medical services would be covered.
And yet, the couple received a medical bill that amounted to more than $700 because the physician who treated Tracey was out of their health insurance network.
Tracey's insurance network negotiated the $1,020 medical bill down to $788 and then to $604, but this amount is still huge, especially because they had a $6,000 deductible to begin with, according to NBC News.
"When we pay our $6,000 deductible, and then you still get this bill for another $604, it's just not right," said Tracey.
How Can It Be Prevented?
Cooper and his colleagues' proposed solution is the introduction of legislation that addresses the issue of surprise medical bills.
Specifically, they propose that hospitals should be required by law to offer an emergency care package that includes both physician services and facility fees. The hospital would become responsible for staffing the ER and paying the physicians directly.
Fiona Scott Morton, one of the study's authors, said such a law would preserve competition among hospitals, doctors and insurance carriers.
"Most importantly, it would ensure that when patients visit the emergency department, they aren't surprised by expensive medical bills," added Scott Morton.
But not everyone agrees. Rebecca Parker, president of the American College of Emergency Physicians, questioned Cooper and his colleagues' findings.
"The data do not make sense and, in some cases, border on preposterous," she said.
Parker argues that the research did not discuss the fact that "insurance companies mislead patients" by selling "affordable policies that cover very little expenses until large deductibles are met." She added that physicians are being blamed for the charges.
Meanwhile, details of the study are published in the New England Journal of Medicine.
