Surprise! Out-of-Network Billing for Emergency Care in the United States

@article{Cooper2017SurpriseOB,
  title={Surprise! Out-of-Network Billing for Emergency Care in the United States},
  author={Zack Cooper and Fiona M. Scott Morton and Nathan Shekita},
  journal={Health Economics eJournal},
  year={2017}
}
Using insurance claims data capturing 8.9 million emergency episodes, we show that in 22% of cases, patients attended in-network hospitals, but were treated by out-of-network physicians. We find that out-of-network billing is concentrated in a small group of primarily for-profit hospitals. Within 50% of hospitals in our sample, fewer than 5% of patients saw out-of-network physicians. In contrast, at 15% of hospitals, more than 80% of patients saw out-of-network physicians. Out-of-network… Expand
Regulating Out-of-Network Hospital Payments: Disagreement Payoffs, Negotiated Prices, and Access
Recent policy proposals seek to regulate the prices that hospitals can levy for care delivered outside of a patient’s insurance network. In this paper, we study the potential effects of suchExpand
Disagreement Payoffs and Negotiated Prices: Evidence from out-of-Network Hospital Payments
Recent policy proposals seek to regulate the prices that hospitals can levy for care delivered outside of a patient’s insurance network. In this paper, we study the potential effects of suchExpand
"Surprise" Out-of-network Billing in Orthopedic Surgery: Charges From Surprising Sources.
TLDR
This study sought to determine the providers responsible for the highest rates and costs of out-of-network billing in orthopedic surgical episodes across the United States. Expand
Private Equity Buyouts in Healthcare: Who Wins, Who Loses?
Private equity firms have become major players in the healthcare industry. How has this happened and what are the results? What is private equity’s ‘value proposition’ to the industry and to theExpand
Long-Term Care Hospitals: A Case Study in Waste
TLDR
It is found that most LTCH patients would have counterfactually received care at Skilled Nursing Facilities and that Medicare could save about $4.6 billion per year – with no harm to patients – by not allowing for discharge to LTCHs. Expand
Not the Last Word: Surprise Medical Bills are Hardly Charitable.
  • J. Bernstein
  • Medicine
  • Clinical orthopaedics and related research
  • 2020
TLDR
Three rules are needed in the new law to protect patients from unexpected charges from a provider who does not participate in a patient’s health insurance plan (a so-called outof-network provider), because there are at least three types of surprise medical bills. Expand
Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes
The past two decades have seen a dramatic increase in private equity investment in healthcare, a sector in which intensive government subsidy and market frictions could lead high-powered for-profitExpand
Three Essays In Health Policy and Economics: Surprise Out-of-Network Medical Bills and Out-of-Network Health Care Provider Payment in the United States
Three essays addressing surprise out-of-network medical bills and out-of-network health care provider payment.
Check Up Before You Check Out: Retail Clinics and Emergency Room Use
Abstract Given concern about inefficient use of the emergency room (ER) increasing health care costs, we use all ER visits in New Jersey from 2006 to 2014 to examine the impacts of retail clinics onExpand
Why is End-of-Life Spending So High? Evidence from Cancer Patients
TLDR
It is found that among patients with the same cancer type and initial prognosis, end-of-life spending is substantially more elevated for younger patients compared to older patients, suggesting that treatment decisions are not exclusively present-focused. Expand
...
1
2
3
...

References

SHOWING 1-10 OF 107 REFERENCES
Emergency department profits are likely to continue as the Affordable Care Act expands coverage.
TLDR
Assuming current payer reimbursement rates, ACA reforms could result in an additional 4.4-percentage-point increase in profit margins for hospital-based EDs compared to what could be the case without the reforms. Expand
Out-of-network physicians: how prevalent are involuntary use and cost transparency?
TLDR
Policy interventions can increase receipt of cost information prior to using out-of-network physician services, but they may be less helpful when patients have constrained physician choice due to emergent problems or limited in-hospital physician networks. Expand
Balance Billing by Health Care Providers: Assessing Consumer Protections Across States.
TLDR
Most states do not have laws that directly protect consumers from balance billing by an out-of-network provider for care delivered in an emergency department or in-network hospital, and gaps remain even in these states. Expand
Hospitals as Insurers of Last Resort
TLDR
The results suggest that each additional uninsured person costs local hospitals $900 each year in uncompensated care, suggesting that non-profit hospitals serve a unique role as part of the social insurance system. Expand
Factors associated with closures of emergency departments in the United States.
TLDR
From 1990 to 2009, the number of hospital EDs in nonrural areas declined by 27%, with for-profit ownership, location in a competitive market, safety-net status, and low profit margin associated with increased risk of ED closure. Expand
Influence of out-of-network payment standards on insurer-provider bargaining: California's experience.
  • E. Duffy
  • Medicine
  • The American journal of managed care
  • 2019
TLDR
California's experience demonstrates that OON payment standards can influence the payer-provider bargaining landscape, affecting network breadth and negotiated rates. Expand
Out-of-Network Emergency-Physician Bills - An Unwelcome Surprise.
Patients who seek care at in-network emergency departments may learn later that they owe thousands of dollars for a treating physician who isn't in their plan's network. But states could requireExpand
Variation in the Ratio of Physician Charges to Medicare Payments by Specialty and Region
TLDR
A national study was conducted to understand the extent and variation of physician excess charges and to suggest strategies to reduce these charges. Expand
The Anatomy of Physician Payments: Contracting Subject to Complexity
Why do private insurers closely link their physician payment rates to the Medicare fee schedule despite its well-known limitations? We ask to what extent this relationship reflects the use ofExpand
Do health insurers innovate? Evidence from the anatomy of physician payments.
TLDR
Heterogeneity in the pervasiveness and direction of deviations suggests that the private market coordinates around Medicare's pricing for simplicity but abandons it when sufficient value is at stake. Expand
...
1
2
3
4
5
...