Jun 7, 2019

ER bills are skyrocketing

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Data: Health Care Cost Institute; Table: Naema Ahmed/Axios

Emergency rooms' prices are skyrocketing, and experts say that may be a side effect of the same factors that leave patients on the hook for unexpected bills.

Why it matters: Emergency rooms are collecting more money from private insurance plans, and at the same time they're also surprising patients with the news that their care wasn't covered. So whether you're covered or not, you're paying more.

The big picture: Hospitals get paid more for complex treatments than simple ones. Over the past decade, they've been categorizing more and more visits as complex, while also raising their prices for complex care.

  • Since 2008, the prices hospitals negotiate with insurers have gone up, as have patients' out-of-pocket costs, according to the Health Care Cost Institute.

Between the lines: HCCI's analysis doesn't include ER care that isn't covered by insurance — and that's the source of many of the surprise bills that have sparked so much political controversy.

  • But experts say the two issues are connected.
  • Patients get surprise bills when a specific ER doctor doesn't accept their insurance. The threat of those bills also gives doctors more leverage to demand higher rates from the insurance plans they do accept.

"A lot of the increase in code-specific rates likely stems from emergency physician groups more fully utilizing the leverage from the threat to surprise bill patients," Brookings' Loren Adler said.

What's next: Policymakers — in Congress and in the states — are eyeing a variety of ways to rein in surprise billing.

  • The most aggressive approach would likely be to simply mandate the rate doctors can charge for out-of-network care.
  • An arbitration process would likely be "the least aggressive option," Yale's Zack Cooper said.

Go deeper: We all pay for surprise emergency room bills

Go deeper

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