Most of us will end up in an emergency room at some point. And when we do, we’ll probably have no choice which physicians treat us and no ability to ensure they are part of our insurance company’s network of preferred providers.
As Texas consumers, we may reasonably expect that if treated in an in-network hospital in an emergency, the doctors practicing within that hospital would also be in that same network. This is too often not the case, leaving us vulnerable to surprise medical bills, known as “balance bills,” from out-of-network physicians based at hospitals.
Our new report, Surprise Medical Bills Take Advantage of Texans, analyzes data from Texas’ three most popular insurers: Blue Cross Blue Shield, Humana and United Healthcare. According to the analysis, it is common for Texans who receive care in an in-network emergency room to receive treatment from an out-of-network doctor. There are some hospitals, in fact, where zero emergency room doctors at the facility are in-network under the popular insurance plans accepted by that hospital.
The report outlines several policy recommendations that could improve medical price transparency. These include protecting consumers in emergencies, when they can’t select their provider, by guaranteeing that they receive in-network rates at in-network hospitals.