• Unexpected out-of-network care can occur in any setting and with any specialty, but it is most prevalent in emergency services and rural areas.
  • 62 percent of ER doctors say most health insurance plans provide less than adequate coverage for emergency care visits.
  • Most physicians and physician practices prefer to be in-network, even at a discount. Doing so means higher patient volume, greater referrals, lower administrative costs, fewer denials, and guaranteed payment.
  • If a health plan provides adequate networks and fair compensation for services, then balance billing is not necessary. However, insurance companies are increasingly forcing providers out of their networks while raising premiums and cost-sharing requirements, shifting costs to doctors and patients.

End the Surprise Insurance Gap

Some health plans intentionally provide narrow networks so that patients are likely to require out-of-network service with reduced out-of-network coverage. By doing so, the cost of providing care is shifted to the patient and providers. In many cases, patients are unable to afford the cost sharing requirements for unexpected medical care which places a financial burden on both patients and providers. As community employers, inadequate reimbursements from insurers coupled with uncompensated care can negatively impact physician practices’ ability to retain nurses, nurse practitioners, physician assistants, and other staff in order to best serve their patients.

When establishing a minimum payment standard for unexpected out-of-network care with a ban on balance billing, legislation must allow for the continuation of resources necessary to maintain specialty and emergency services, especially in rural areas. It must allow them to retain – and even attract – physicians to their communities and to keep rural emergency room doors open. The same is true for those areas with a high prevalence of uncompensated or undercompensated care.

Benchmarking to a transparent, independent charge-based database comes closer to covering the actual cost of providing care (though still at a reduction) which allows physicians to continue to serve communities with the necessary emergency services and medical resources without extra government funding.

See Who Stands for Fair Coverage

American College of Emergency Physicians
American College of Radiology
American Society of Plastic Surgeons
Emergency Department Practice Management Association
National Patient Advocate Foundation
Physicians for Fair Coverage
Georgia Chapter of the American College of Physicians
Georgia College of Emergency Physicians
Georgia Orthopaedic Society
Georgia Psychiatric Physicians Association
Georgia Society of Ambulatory Surgery Centers
Georgia Society of the American College of Surgeons
Georgia Society of Anesthesiologists
Medical Association of Georgia
Tennessee Psychiatric Association

Join the fight!