Dive Brief:
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Sen. Claire McCaskill (D-Mo.) has joined the chorus of people concerned about surprise billing in the wake of a New York Times article published in July.
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The NYT wrote about the practice of companies billing emergency room (ER) patients for out-of-network charges. The article featured Envision Healthcare subsidiary EmCare, one of the country’s largest physician-staffing companies for ERs.
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McCaskill recently sent a letter to Envision CEO Chris Holden asking a series of questions, including what percentage of ER visits with EmCare physicians result in out-of-network billing and how much patients pay in out-of-pocket costs.
Dive Insight:
McCaskill may be looking into federal legislation to limit surprise billing, which is a rising concern for patient advocates. Envisions has found itself in the midst of quite a controversy since the ER billing issue has come to light.
EmCare provides ER physicians to hundreds of hospitals. McCaskill said that, given the company’s growing footprint, it’s important for Congress to understand “pricing practices and the steps the company intends to take to address concerns about cost and care.”
Surprise billing, also called balance billing, is leaving confused patients with larger-than-expected hospital bills. A patient can visit an in-network hospital and have no idea that an out-of-network physician, who is with a physician-staffing company, is providing care. That leads to the patient getting billed for out-of-network care and paying more for their hospital visits.
This is especially a problem in ERs. A National Bureau of Economic Research study this year found patients who visited in-network hospitals for emergency care received out-of-network physician care 22% of the time. The Commonwealth Fund also released a report on surprise billing in June, which estimated that 14% of ER visits and 9% of hospital stays were likely to produce a surprise bill. One-fifth of admitted patients via the ER were more likely to receive a surprise bill.
The problem is made worse because few states legislate against the practice. The Commonwealth Fund said only six states have “comprehensive” laws that protect against surprise billing, and there are no federal protections against the practice.
Texas took a baby step by implementing a law this month that requires freestanding ERs to notify patients of their insurance networks, in hopes of reducing surprise billing. The Texas law could be the start of a regulatory avalanche against surprise billing, especially with an influential Democratic senator turning her sights on the practice. McCaskill asked Envision to respond with its answers by Oct. 11.
McCaskill's letter is just the latest in the Envision Healthcare/EmCare surprise billing story. After the article in the Times, a group of investors filed a lawsuit against Envision Healthcare claiming the company did not tell them that its subsidiary EmCare overcharges patients and conducts surprise billing. The investors said company “revenues were likely to be unsustainable" because of the negative publicity.