1 big thing: We all pay for surprise medical bills

Axios
1/28/19

Surprise medical bills have received a lot of attention recently for the financial distress they cause their recipients. But they can also lead to the rest of us paying more for health care.

  • Emergency room doctors can use the threat of high out-of-network bills to negotiate higher payment rates with insurers, experts say, raising premiums.

Between the lines: If an insurer doesn’t agree to a high enough rate, there’s the option to charge for out-of-network care. This can result in higher emergency room rates across the board.

Details: A Yale study last year, analyzing data from a large insurer, found that when 1 of the 2 largest ER staffing firms, EmCare, entered a hospital, total payments to the insurer increased by 122%.

  • The second firm, TeamHealth, used the threat of leaving a network to get 68% higher in-network rates. Overall, ER doctors’ in-network rates were 266% of what Medicare pays, which is higher than most other specialists.
  • Hospitals can also benefit. For example, after EmCare entered a hospital, facility payments increased by 11%, the Yale study found.

Yes, but: “This is a specific niche of providers who have found this unethical, narrow wedge in the system where they can make significant amounts of money off the backs of patients,” Yale’s Zach Cooper, an author of the study, told my colleague Bob Herman.

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