Today’s Managing Health Care Costs Number is $622.55
Percentage of ED visits with out of plan physician charges
The New England Journal yesterday published evidence that the problem of out of network providers in “in network” emergency departments (EDs) is in the words of the authors “deeply troubling.”
Researchers looked at over 2 million emergency department visits from a large national insurer – these represented all 50 states and they had adequate claims volume to draw conclusions on 294 of 306 hospital referral regions.
20% of these emergency department visits involved “out of plan” physicians – whose bill on average would have left patients responsible for $622.55 per ED visit – some portion of which might be paid by a health plan. The out of plan physicians’ rates were eight times higher than the Medicare fee schedule. Some geographies had no out of plan ED physicians (South Bend, IN and Boulder CO). In McAllen TX, nearly 9 of 10 emergency department visits included out of plan physicians. In St Petersberg, FL, this was true of over 6 in 10 ED visits.
The American College of Emergency Physicians thinks that a parody ad video and selective studies in single geographies will take attention away from this very meaningful issue. I doubt it. People are hurting from the high cost of health care. This can be excessive out of pocket costs built into health plan design, or it can be from high charges from out of plan physicians. Californiapassed legislation setting maximums for such charges – we should expect to see more legislation like this around the country in the coming months and years.
The American College of Emergency Physicians parody of a CIGNA ad - which blames the carriers for high out of pocket costs. This research refutes that contention
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