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Surprise! : Out-of-network billing for emergency care in the United States

Author: Zack Cooper; Fiona Scott Morton; Nathan Shekita; National Bureau of Economic Research,
Publisher: Cambridge, Mass. : National Bureau of Economic Research, 2017.
Series: Working paper series (National Bureau of Economic Research), no. 23623.
Edition/Format:   eBook : Document : EnglishView all editions and formats
Summary:
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  Read more...
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Material Type: Document, Internet resource
Document Type: Internet Resource, Computer File
All Authors / Contributors: Zack Cooper; Fiona Scott Morton; Nathan Shekita; National Bureau of Economic Research,
OCLC Number: 1000313171
Notes: "July 2017"
Includes online data appendix.
Description: 1 online resource (60, 31 pages) : illustrations, maps.
Series Title: Working paper series (National Bureau of Economic Research), no. 23623.
Responsibility: Zack Cooper, Fiona Scott Morton, Nathan Shekita.

Abstract:

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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