Out-of-network ER Pay & Charges Fuel Ire From Docs & Patients Alike

Employee benefits consultant broker New Jersey

The quarrel over surprise medical bills continues to escalate, and emergency room physicians are now suing the Obama administration in a bid to shift more of the blame to insurers.

The Affordable Care Act includes a provision intended to mitigate the negative impact on patients when they get emergency care from providers who aren’t part of their health plan’s network, and HHS’ regulations on the provision lay out a framework for what those providers should get paid.

The American College of Emergency Physicians says its members have been cornered into choosing between balance billing and finding a new line of work. The organization argued in a lawsuit filed last week that HHS allows insurers to determine out-of-network rates based on their proprietary databases of historical charges.  For out-of-network emergency care, the law bars insurers from charging patients higher coinsurance and copayments. But it doesn’t prohibit balance billing or require insurers to cover those bills.

Read the full article from Modern HealthCare!

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