Blame insurance companies, not docs, for ‘surprise’ bills

Emergency room sign
Blame insurance companies, not emergency room physicians, for "surprise" bills, says a group of emergency physicians. (Getty/Nils Versemann)

Insurance companies are to blame for patients receiving "surprise" bills after a visit to the emergency room, not the doctors who treat them, according to one physician group.

Health insurance companies are misleading their customers and the public when they blame physicians for unexpected bills that result when a patient is treated by a physician who is out of network, according to Rebecca Parker, M.D., president of the American College of Emergency Physicians.

"Several recent news reports present inaccurate, one-sided perspectives of the ‘surprise billing’ issue, exaggerating the severity of the problem and placing the blame on physicians, when in fact it is the insurance companies who are gaming the system, and taking blatant advantage of their customers, who are our patients,” Parker said in a statement issued in response to a recent research letter in JAMA.

The JAMA study found that nearly all doctors bill patients far more than what the Medicare program pays and said those high rates can impose financial burdens on uninsured patients and privately insured patients using out-of-network physicians. While the researchers didn’t specifically target emergency room physicians, they found that medical specialties that had the greatest charges above Medicare rates are those where patients do not choose their physicians, including emergency medicine.

Parker said insurance companies need to shoulder the blame for the out-of-network billing in emergency medicine because they are narrowing their networks, making it more likely patients will be treated by a doctor not covered by their insurance. Emergency physicians would like to see states adopt consumer protection legislation similar to that recently passed in Connecticut, which requires the use of an independent and transparent charge database to determine reimbursement for emergency services received out of network, she said.

Many states have been taking action to address the problem of surprise billing. In Georgia, two state lawmakers have introduced bills to try to protect patients from surprise bills, according to the Gwinnett Daily Post.

Significant copays and high deductibles put in place by insurance companies also create financial issues for patients and can discourage them from seeking medical attention when they are sick or injured, Parker said.

2016 study found that nearly a quarter of patients who received emergency care at an in-network hospital were surprised to learn that they were treated by an out-of-network physician when they got unexpected bills.