Dive Brief:
- UnitedHealthcare is making a change this year to cut costs. It will no longer pay the fees for some out-of-network emergency room physicians and other specialists, even if they are treating patients at in-network hospitals.
- The insurer says that now, it will limit payment to the prevailing out-of-network rate. Patients will receive the remainder of the bill.
- UnitedHealthcare says hospitals are responsible for the issue because of their decision to contract work to providers outside the insurer's network.
Dive Insight:
Balance billing has posed an issue for other insurers as well. As the St. Louis Post-Dispatch notes, Anthem Blue Cross Blue Shield made a similar move several years ago, while Coventry Health Care continues to pay the full cost.
UnitedHealthcare told the Post-Dispatch it is "deeply concerned that some hospital-based physicians are establishing out-of-network strategies to seek excessively high reimbursement levels, sometimes more than 10 times what an in-network physician would charge for the same service."
Some states have worked to regulate the issue. The Post-Dispatch reports that most states ban balance billing for Medicaid managed care patients, and about half ban it for private insurance patients.