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The Latest Research, Commentary, And News From Health Affairs

Wednesday, April 7, 2021

Dear John,

Roughly one in five emergency department visits involve an
out-of-network provider, leaving many patients vulnerable to surprise
medical bills. A new paper explores the costs to patients and benefits
for physicians.

Patients Pay Ten Times More For Emergency Care If It's Out-Of-Network

Surprise medical bills can occur when a patient with private health
insurance unexpectedly or involuntarily receives care from an
out-of-network provider and is billed for the uncovered portion.
Patients using the emergency department are particularly susceptible to
surprise bills because doctors aren't always in the same networks as
the hospitals where they practice.

In a new Health Affairs article in the April issue, Adam Biener and his
colleagues measured how much privately insured emergency department
patients paid when they received a surprise bill

and how much physicians received in these situations. They analyzed
survey data and found that patients who likely received a surprise
out-of-network bill for emergency care paid physicians more than ten
times as much as other emergency patients paid. In addition, physicians
on average collected a larger share of the total bill for out-of-network
care than for in-network care.

These findings have serious implications for both payers and hospitals,
as reflected by the bipartisan effort in Congress to end most instances
of surprise billing. In a recent blog post, Jack Hoadley, Katie Keith,
and Kevin Lucia unpacked the No Surprises Act
,
which was included in the omnibus spending bill that President Trump
signed in December.

Today, Health Affairs Blog features two new posts by Katie Keith. In the
first, she discusses how, while the country waits for the Supreme
Court's decision in California v. Texas, insurers have asked the court
to review an appellate decision

reducing their potential recovery for unreimbursed cost-sharing
reductions. In the second, Keith covers the recent news that more than
528,000 people have enrolled in Marketplace coverage during the broad
special enrollment period
.
This includes more than 206,000 consumers who selected a plan in
February and 322,000 consumers who did so in March.

In another new blog post, James D. Chambers and Peter J. Neumann argue
that more transparency about how drug coverage decisions are made

would benefit patients, physicians, and the health care system.

For free content about all things pandemic related, check out our
COVID-19 Resource Center
.

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Your Daily Digest

Emergency Physicians Recover A Higher Share Of Charges From
Out-Of-Network Care Than From In-Network Care

Adam I. Biener, Benjamin L. Chartock, Christopher Garmon, and Erin Trish

Unpacking The No Surprises Act: An Opportunity To Protect Millions

Jack Hoadley, Katie Keith, and Kevin Lucia

ACA Litigation Round-Up, Part 1: Fight Over Reimbursements For
Cost-Sharing Reductions Continues

Katie Keith

HealthCare.gov Enrollment Continues To Rise During Special Enrollment
Period

Katie Keith

A Next Frontier In Health Care Transparency: Health Plan Drug Coverage
Policy

James D. Chambers and Peter J. Neumann

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The Health Affairs Podcast Fellowship is an exciting new program for
US-based applicants. The program is intended for early- or
mid-early-stage career individuals with an interest in health policy
and storytelling.

The program is intended to support applicants who have an audio project
in mind to inform and educate the public. Applicants should have a
working knowledge of the topic and an idea of what's needed to
complete their project (interviews, data, field recordings, etc.).

Each fellow will produce a podcast series of at least four episodes
using interviews, background briefs, public data, Health Affairs
research, and other materials to tell the story.

Candidates are expected to be US-based print or radio journalists,
freelance storytellers, solo-preneurs, or academics. The fellowship is
designed to enable fellows to work independently over a five-month
period (June to October) to produce a podcast series/story of at least
four episodes, which Health Affairs will publish soon after.

Apply Today

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About Health Affairs

Health Affairs is the leading peer-reviewed journal
at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org , Health Affairs Today
, and Health Affairs Sunday
Update .  

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health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

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