Inflated Charges Cost Privately Insured Individuals More Each Year

According to a recent report from UnitedHealth Group, individuals enrolled in private insurance, seeking emergency care from their in-network hospital emergency departments (EDs), are often treated by out-of-network (OON) physicians and charged higher amounts, resulting in nearly $6 billion in inflated costs.

 “These physicians typically are not employees of the facilities in which they practice,” UnitedHealth Group said. “By opting out of the EDs’ health plan networks, these physicians retain the market power to inflate prices to captive ED patients who cannot choose which physicians treat them.”

In 2017, the inflated charges for privately-insured individuals treated at in-network ED resulted in inflated costs of approximately $6 billion. The report also showed:

• OON emergency physicians charged an average of $538 (150%) more per ED visit than in-network emergency physicians were paid ($898 vs $360).
• Over one-quarter of visits to in-network EDs resulted in OON physician charges (12 million out of 44 million).

Among the highest inflations for treatment by OON physicians during in-network ED visits was abdominal pain, resulting in an average 138% escalation in treatment cost ($1044 vs $439), and an additional $1.9 billion overall. Breathing problems increased health care costs an additional $1.6 billion with treatments costing 158% more.

Ear infections top the list with the most inflated charge from OON emergency physicians compared to in-network payments—$639 vs $238, a 168% hike.  

The report goes on to state that patients only become aware of the increased charges after treatment in the form in surprise billing—an issue currently being scrutinized by lawmakers.

—Edan Stanley

Reference:

UnitedHealth Group. Out-of-Network Emergency Physicians Increase Health Care Prices for Consumers by $6 Billion Each Year. 2019. https://www.unitedhealthgroup.com/content/dam/UHG/PDF/2019/OON-ED-Physicians_Final_March-2019.pdf. Accessed 18 Mar 2019.