ER physicians increasingly stay out of provider networks

Patients who use an in-network hospital for emergency room (ER) visits sometmes get an unwelcome surprise: there is no guarantee the care is rendered in-network, the New York Times reported.

If an ER physician is not part of a patient's insurer network, the patient can receive bills for out-of-network charges. Take for example, Craig Hopper, who specifically went to an in-network hospital's ER after he was struck in the face. Hopper faced a $937 bill from the ER physician.

"It never occurred to me that the first line of defense, the person you have to see in an in-network emergency room, could be out of the network," Jennifer Hopper, Craig's wife, told the Times. "In-network means we just get the building? I thought the doctor came with the ER."

This issue is commonplace in hospitals where patients seek care. Many patients do not think to ask for in-network providers specifically,and many providers do not disclose such information as they arrange to deliver care.

A growing number of emergency medicine physicians are private contractors who do not necessarily participate in insurance networks, according to the Times. In Texas, for example, up to half the hospitals that were in major insurers' networks did not have in-network physicians.

"It's very common and there's little consumers can do to prevent it and protect themselves--it's a roll of the dice," said Stacey Pogue, a senior policy analyst for the Center for Public Policy Priorities, which has studied the issue closely.

It makes more financial sense for ER docs to avoid provider networks altogether, as payers clamp down on reimbursements. As a result, the average compensation for an ER doctor rose more than 25 percent between 2010 and 2014, according to the article.

To learn more:
- read the New York Times article