Out-of-Network Emergency-Physician Bills – An Unwelcome Surprise

New England Journal of Medicine, 375(20): 1915-1918

This paper explores the frequency and consequences of surprise out-of-network billing for emergency care. We find that 22 percent of in-network visits to an emergency room involved out-of-network physicians. Patients face an average balance bill of $622.55 if their insurer only covers standard in-network physician rates.

Our results are deeply concerning: of the 99.35% of ED visits that occurred at in-network facilities, 22% involved out-of-network physicians. This figure masks significant geographic variation in surprise-billing rates among HRRs. In McAllen, Texas, and St. Petersburg, Florida, surprise-billing rates were 89% and 62%, respectively (see map). In contrast, in Boulder, Colorado, and South Bend, Indiana, the surprise-billing rate was near zero, suggesting that surprise billing is a solvable problem