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ACEP Takes Stance on Who Is to Blame for 'Surprise Billings'


In response to a recent UnitedHealth Group analysis of out-of-network billing, Vidor Friedman, MD, FACEP, president of the American College of Emergency Physicians (ACEP), said:

"Insurers like UnitedHealth Group, yet again, prefer to shift the blame for their increasingly narrow networks to physicians. These same insurance companies are less likely to mention that right now they actually benefit each time a patient receives out-of-network care, because the patient will often pay more of the total bill from their own pocket, due to higher out-of-network deductibles, before the insurance company ever chips in.

The reality is that while overtly taking steps to keep physicians out-of-network, insurers are shifting blame to physicians and, even worse, shifting more and more costs to their own beneficiaries. Unfortunately, these unscrupulous tactics by insurers such as UnitedHealth are not new, as noted by a federal judge who recently found that a UnitedHealth subsidiary was "deceptive" and "evasive" in efforts that can hinder access to care. Patients must be protected, and this must stop.

ACEP is working with bipartisan members of the House and Senate to protect patients and end 'surprise billing.' By oath and by law, emergency physicians will treat any patient, regardless of their ability to pay."

One proposal in ACEP's Framework for Protecting Emergency Patients is to level deductibles for out-of-network emergency care so that they are no higher than those for in-network care. When facing an emergency, patients or their family members don't have time to figure out where their care will be in-network and they shouldn't be punished financially for it.

UnitedHealth's analysis references out-of-network emergency physicians "opting out" of EDs' health plan networks, as though insurers have no agency in such negotiations and contracting between insurers and providers only involves one party. The brief also fails to acknowledge that under the Affordable Care Act, commercial insurers may apply a higher deductible for out-of-network emergency care. With out-of-network deductibles of $5,000, $7,000 or even $10,000 increasingly common, UnitedHealth actually benefits when they themselves "opt out" of bringing emergency physicians into their plan networks.

ACEP's Framework calls for insurers to serve as a single point of contact to the patient for medical billing and payment. Hopefully, this helps patients avoid confusion from having to reconcile multiple bills and explanations of benefits that can result from the many providers who often need to be involved in a single emergency episode. And, this makes sense because the insurer is the only entity involved in a patient's care that has all the information--information on providers' network status, the patient's cost-sharing amounts for a particular insurance product, and how much of their deductible they have met so far in that plan year.

ACEP welcomes a discussion about steps that can be taken to protect and inform patients, take patients out of the middle of provider/insurer billing disputes, and puts an end to patients being surprised by how little their insurance covers.

Click here for more information about the ACEP Framework to Protect Patients From Out-Of-Network Billing Issues.


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Insurance, Insurers, Surprise Billing
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