Balance billing squeezes patients: ‘Everyone who's in this building should be in my network’
Patients often assume that by going to a hospital in their insurance network they will avoid any big bills, but many in Texas are finding out too late their emergency room visit included care from an out-of-network physician.
The Houston Chronicle reported this “may be no accident"—48 percent of overall claims from ER doctors were outside the state’s three largest insurance networks, far higher than any other specialty. The physicians argue it’s because patients don’t understand what’s covered by their plan, but for 89 percent of ER claims in the state, the hospital or freestanding department was in network.
That means an unexpected out-of-network ER visit for as high triple the in-network rate for people like Jason Pettit, who had to rush his 7-year-old daughter to Clear Lake Regional Medical Center in Webster, Texas, when their dog bit her face.
“I'm at a hospital that is in my network. Everyone who's in this building should be in my network,” he thought. “It didn't occur to me it could be any different.”
Instead, he was saddled with $1,311 bill for an ER physician, a $900 balance for an out-of-network surgeon and a $1,413 balance for anesthesia.
Rather than an unfortunate accident, the Chronicle suggested this is a deliberate strategy from ER staffing firms like Envision Healthcare to increase their prices and profit margins. A Yale University study found that out-of-network ER billing went “virtually from zero to nearly 100 percent” in 16 hospitals where Envision took over.
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John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.