Trick and Trap in the Emergency Room

Last week, I read Ending This Fee for All (an Op-Ed by Devin Fergus from the New York Times) about an AT&T agreement to reimburse customers for "hidden" trick-and-trap fees lurking in cellphone contracts. Devin Fergus uses "hidden" in quotes, I assume, because the charges at issue where entirely permissable under the terms of the cell phone agreement. 

All of this has me thinking again about the problem of in-network Emergency Rooms staffed by out-of- network Emergency Room doctors. This is when a conscientious health plan enrollee travels to an in-network Emergency Room (often bypassing out of network Emergency Rooms along the way) only to discover, at the time of billing, that the Emergency Room may have been in-network but the independent contractor physicians employed there were not and will be billing the patient at out-of-network rates.

Nicholas Bagley has written about the need to end these "abusive billing practices" and would have HHS invoke its authority to guarantee adequate networks to require Emergency Rooms to have a negotiated in-network contract with plans sold through the exchanges. The problem with that is that, last time I looked, only seven million Americans are insured through the exchanges. What about the rest?

Would better signage matter?  Would most Americans understand the out-of-pocket implications of a sign that said: "Be Advised: The Emergency Room Physician You See Here is Not an Employee of This Hospital"?  Given our current state of  health insurance literacy, I doubt it. For those with the resources, there is an industry of representatives who can attempt to thrash this out between you, your Emergency Room provider, and your insurer.

Of course what is really at stake here is a tremendous power struggle between Emergency Room physicians and hospitals over contract rates, each hoping to harness the consumer discontent with trick and trap in the Emergency Room to their positions at the bargaining table. Hard to say who will eventually come out the winner, though patients who may not even have access to an in-network Emergency Room contracted with an in-network Emergency Room physician in their network will be the out-of-pocket losers.

I wonder if all of this won't magnify hospital interest in acquiring more phsyician groups. And a little voice always makes we want to ask the many advocates for "patient education" if this was the kind of thing they were planning to explain to the American public?