December 2019

Abstract 18: Out-Of-Network Billing For Privately Insured Patients

EMA 2019 December32 Chapters

  1. Introduction6:16
  2. Ultra Summary27:00
  3. Time To Talk A Little Nerdy: The Hawthorne Effect11:13
  4. Farewell1:29
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Edward B. -

Gents, a couple of questions? Have either of you ever negotiated with an insurance company for your own or a groups reimbursement contract? Have either of you ever been in a leadership position in an independent practice of Emergency Medicine at a small or mid size community hospital? Do you have information, for those groups that have no network contracts that may submit a bill and then balance bill, on what the rate of final resolution is on the balanced billed? What percentage is settled on a percentage of the bill submitted? What percent are eventually forgiven? What is the average balance billed?

"33% of ED's always generated an out of network bill, that my friends is gross". " Insurance companies won't pay trumped up charges. " Could you explain these comments?

Does the paper address the situation of the on network hospital allowing a contracted provider group to remain out of network? Why do they permit it?

Perhaps I am completely off . I don't know either of you, but I believe this issue is more complex than you may have portrayed it. I believe that a more in depth study of why this issue has developed this way might cause you to dial down the outrage. Actually I am offended that you have assumed that ED groups are treating their patients dishonestly. I am sure there are some. I am sure that most do not. I am sure that there are academic, university based emergency physicians who understand all aspects of the business of emergency medicine. I suspect most do not.

Ed Boudreau, DO, FACEP, FAAEM

Matthew L. W. -

Agree with above. Balance bills are typically in the 100-200 dollar range and pale in comparison to hospital charges. Having insurance doesn't mean you can access health care without bills. I get "balanced billed" by every provider my family goes to. Balance bills are created by insurance companies trying to increase stock prices. Enough physician bashing. We deserve what we are paid and more. We save lives.

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