Our consumer attorneys are investigating allegations that patients who go to an in-network medical facility are being charged inflated rates for out-of-network services by a company called EmCare, owned by Envision Healthcare Corporation.
Patients Often Seek Treatment at In-Network Facilities
Medical debt is among the top causes of bankruptcy in the United States, and to avoid enormous medical bills, patients often make sure to go to a facility that is considered “in-network” for their insurance company. Many types of insurance plans cover in-network treatment completely, only requiring that the patient pay a fixed co-pay (such as $100 for an ER visit).
But, many health plans do not cover out-of-network services, at least not fully. A plan might cover only 25 percent of the total bill for out-of-network treatment. So, in this example, it’s $100 for an in-network ER visit, and three-fourths of the total bill for an out-of-network visit.
NY Times: Consumers Who Went to In-Network Facilities Got “Surprise Bills” for Out-of-Network Services
According to The New York Times, patients who went to in-network hospitals that had contracted with EmCare were often surprised later with an enormous medical bill for out-of-network treatment. EmCare is one of the nation’s largest providers of physician staffing services. Hundreds of hospitals from “across the country” that are struggling to fully staff their ERs are turning to EmCare for assistance, says the NY Times.
But, after EmCare came in, hospitals have seen their patients bills skyrocket. Although the hospitals have negotiated fees with the major health insurers, “the EmCare physicians were not part of those networks and were sending high bills directly to the patients,” reports the NY Times. At one hospital, for example, the hospital’s own physicians charged $467 for the highest level of care, but Emcare charged $1,649.
The patients have no control over which doctor treats them in the ER. And, patients were not warned in advance when they are treated by an out-of-network EmCare doctor. Patients who thought they were at an in-network facility were often billed as if it was an out-of-network facility.
Study Finds EmCare Bills 6 in 10 patients for Out-of-Network Services, reports NY Times
As the NY Times reports, a study by researchers at Yale “examined nearly nine million visits made to emergency rooms run by a variety of companies between 2011 and 2015,” and found that for half of the hospitals that EmCare entered, “out-of-network billing rose quickly and precipitously.” The study also looked at a “larger sample of 194 hospitals where EmCare worked and found an average out-of-network billing rate of 62 percent, far higher than the national average,” says the NY Times.
The researchers also looked at hospitals entered by EmCare’s competitor, TeamHealth, and according to the NYT, found a significantly “smaller increase in out-of-network billing.”
Fiona Scott Morton, a co-author of the study, said that EmCare’s billing practices were kind of like “ambushing” patients. Dr. Gregory Duncan, chief of surgery at his hospital, says that when EmCare took over, he “discovered a pattern of inflated bills and out-of-network bills. He continued, “What they are doing is egregious billing.”
Consumers Complain about Enormous EmCare Bills
One consumer wrote about EmCare’s doctors in Dallas, Texas:
The physicians bill was over $800 for a 10 minute consultation and diagnosis of an ear infection and sore throat this is outrageous!
Another consumer wrote,
Referred to facility by my primary care for after hours care, insurance co pay taken but billed for out of network doctor who saw me for less than 5 minutes, I did not specifically ask to see this doctor and certainly would not have agreed to see out of network doctor if this had been offered. … The physicians bill was $1,309.00 for a 10 minute consultation.
Many consumers noted that EmCare had sent their enormous bills to a collection agency called Bay Area Credit Service.
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