Surprise! Out-of-Network Billing for Emergency Care in the United States
Using insurance claims data, we show that in 22% of emergency episodes, patients attended in-network hospitals, but were treated by out-of-network physicians. Out-of-network billing allows physicians to significantly increase their payment rates relative to what they would be paid for treating in-network patients. Because patients cannot avoid out-of-network physicians during an emergency, physicians have an incentive to remain out-of-network and receive higher payment rates. Hospitals incur costs when out-of-network billing occurs within their facilities. We illustrate in a model and confirm empirically via analysis of two leading physician-outsourcing firms that physicians offer transfers to hospitals to offset the costs of out-of-network billing and allow the practice to continue. We find that a New York State law that introduced binding arbitration between physicians and insurers to settle surprise bills reduced out-of-network billing rates.
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|Date of creation:||Jul 2017|
|Contact details of provider:|| Postal: National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.|
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- Cooper, Zack & Craig, Stuart & Gaynor, Martin & Van Reenen, John, 2015.
"The price ain’t right? hospital prices and healthspending on the privately insured,"
LSE Research Online Documents on Economics
66059, London School of Economics and Political Science, LSE Library.
- Zack Cooper & Stuart Craig & Martin Gaynor & John Van Reenen, 2015. "The Price Ain't Right? Hospital Prices and Health Spending on the Privately Insured," CEP Discussion Papers dp1395, Centre for Economic Performance, LSE.
- Zack Cooper & Stuart V. Craig & Martin Gaynor & John Van Reenen, 2015. "The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured," NBER Working Papers 21815, National Bureau of Economic Research, Inc.
- repec:hrv:faseco:33471113 is not listed on IDEAS
- Jeffrey Clemens & Joshua D. Gottlieb & Tímea Laura Molnár, 2015. "The Anatomy of Physician Payments: Contracting Subject to Complexity," NBER Working Papers 21642, National Bureau of Economic Research, Inc.
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