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Working Together To Reduce Surprise Bills At The Hospital

posted by AHIP

on August 17, 2018

This week, a report from the Kaiser Family Foundation found more people are facing surprise bills, especially when getting care in hospital emergency rooms.

Health care can be confusing and complicated. That’s especially true when it comes to paying for health care services. We all can do better to inform, educate, and engage consumers. When it comes to paying for services in a hospital, patients often don’t realize that many physicians are independent contractors that work at the hospital, but not for the hospital. That means that hospitals can be in a health insurance provider’s network but the doctors at the hospital might not.

Health insurance providers negotiate lower prices with in-network hospitals and doctors—and depending on the specific insurance, plans cover a significant portion of these costs. But when a doctor is not part of a plan network—even if they separately contract with a hospital to treat patients there—they can charge much higher rates.

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That’s when patients receive a surprise bill. It’s a growing problem that puts patients in a frustrating and costly position.

Consumers and patients would benefit if hospitals and other inpatient facilities would engage in good-faith efforts to ensure that their hospital-based doctors contract with the same health insurance providers as the hospitals. This would go a long way to reduce and prevent consumers from receiving a big surprise balance bill.

It’s important to know where to go if you’re sick or injured, and avoid spending hours—and hundreds of dollars—at the ER for a condition that isn’t serious or life-threatening. So, health insurance providers work hard to educate members about the most appropriate venues for care. They’re updating provider directories; offering access to telehealth services; and promoting value-based, coordinated care.

Doing so helps ensure people are getting appropriate care at the appropriate time and at the appropriate venue—all of which prevents “balance billing” and helps drive down health care costs for everyone.