Research Article
Patients & ConsumersEmergency Physicians Recover A Higher Share Of Charges From Out-Of-Network Care Than From In-Network Care
- Adam I. Biener ([email protected]) is an assistant professor of economics at Lafayette College, in Easton, Pennsylvania.
- Benjamin L. Chartock is a PhD student in the Health Care Management Department at the Wharton School and an associate fellow at the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania, in Philadelphia, Pennsylvania.
- Christopher Garmon is an assistant professor of health administration in the Henry W. Bloch School of Management, University of Missouri Kansas City, in Kansas City, Missouri.
- Erin Trish is the associate director of the Leonard D. Schaeffer Center for Health Policy and Economics and an assistant professor of pharmaceutical and health economics in the School of Pharmacy, both at the University of Southern California, in Los Angeles, California.
Abstract
Surprise medical bills occur when a patient unexpectedly or involuntarily receives care from an out-of-network provider and is billed for the amount not covered by insurance. Past studies were unable to observe whether bills for such care were sent to patients and, if so, how much patients paid directly to out-of-network providers. We used data from the Medical Expenditure Panel Survey to measure how much privately insured emergency patients paid when they likely received a surprise bill and how much physicians received in these situations. Physicians collected 65 percent of the charged amount for likely surprise bills compared with 52 percent for other cases. Patients who likely received a surprise out-of-network bill for emergency care paid physicians more than ten times as much as other emergency patients paid, on average.
