ACEP: Don’t Blame Physicians if Patient Costs for Out-of-Network ED Visits Go Up

If patients start paying more for visiting out-of-network emergency rooms, the American College of Emergency Physicians suggests it will be the government’s fault, not physicians’ or hospitals’. ACEP joined with the Emergency Department Practice Management Association in crafting a response to a new federal rule that would bar insurers from charging plan members higher copayments when they visit out-of-network EDs. That law does not prohibit doctors and hospitals from “balance billing” consumers if the insurers does not pay the full amount billed for the visit. Consumer advocates agree that the new rule does not do enough to protect consumers from paying more out-of-pocket for emergency care, but say ACEP and EDPMA have not provided adequate solutions, either. The physicians want the payment standard to be “usual and customary charges,” adjusted for geographic variations, using a transparent, independent claims database. Some consumer advocates have called for balance billing to be banned altogether.