Dive Brief:
- Patients who visit an in-network hospital often aren't aware that doctors treating them are out of network.This results in patients facing large unexpected charges.
- According to The New York Times, this problem may become much more acute under the Affordable Care Act. While the ACA caps out-of-pocket charges, it doesn't extend that cap to out-of-network providers.
- Some experts believe that the ACA will encourage narrower networks, making the problem with out-of-network charges more pressing.
- State health exchanges may not help address the problem. In New York, for example, none of the health plans listed on the exchange offers out-of-network coverage.
Dive Insight:
The problem of out-of-network providers treating patients in hospitals is not new. But if The New York TImes analysis is correct, the problem could get much worse under the Affordable Care Act. Given the prevalence of out-of-network doctors in hospital care, the ACA has left a major hole in the safety net it's intended to create. Doctors may see a major upsurge in unpaid charges as newly insured patients face unexpected charges from their hospital visit. It may be in everyone's best interest for Congress to amend the ACA to offer some out-of-network spending limits.