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Photo: Mark Kaplan/picture alliance via Getty Images

Surprise medical bills not only provide financial stress to those who receive them, but they also can raise health care costs for everyone else.

How it works: Emergency room doctors can use the threat of high out-of-network bills to negotiate higher payment rates with insurers, raising premiums.

The big picture: Many surprise medical bills occur when a patient goes to an in-network hospital's emergency room, but receives care from an out-of-network doctor.

  • Their insurer then either covers only part of the bill, or in some cases none of it, and the physician bills the patient for the rest.
  • This gives ER doctors leverage in payment negotiations: If an insurer doesn’t agree to a high enough rate, there’s the option to charge for out-of-network care. This can result in higher emergency room rates across the board.

Details: A Yale study last year, analyzing data from a large insurer, found that when one of the two largest ER staffing firms, EmCare, entered a hospital, total payments to the insurer increased by 122%.

  • The second firm, TeamHealth, used the threat of leaving a network to get 68% higher in-network rates. Overall, ER doctors' in-network rates were 266% of what Medicare pays, which is higher than most other specialists.
  • These higher-than-average rates are "not an insignificant part of health system costs, and thus [increase] premiums," said Loren Adler of the USC-Brookings Schaeffer Initiative for Health Policy.

Hospitals can also benefit. "If these docs want to bill [out-of-network], they have to compensate the hospital for the reputational cost of allowing surprise billing at their facility," Adler said.

  • For example, after EmCare entered a hospital, facility payments increased by 11%, the Yale study found.

Yes, but: “This is a specific niche of providers who have found this unethical, narrow wedge in the system where they can make significant amounts of money off the backs of patients," said Yale's Zach Cooper, an author of the study.

— Bob Herman contributed to this report.

Go deeper

Updated 21 seconds ago - Politics & Policy

Bipartisan tributes flood in for "giant of the Senate" Bob Dole

Then-Vice President Joe Biden and former Sen. Bob Dole at an event put on by the World Food Program where he was awarded the first “McGovern-Dole Leadership Award” in December 2013. Photo: Douglas Graham/CQ Roll Call

Republican and Democratic politicians, including former Senate colleagues, are sharing condolences and memories commemorating the life of Bob Dole, who passed away at 98 on Sunday morning.

The big picture: Dole, the Republican presidential nominee in 1996, was the longest serving Republican leader in the Senate until 2018, when current Senate Minority Leader Mitch McConnell surpassed his record.

Former Sen. Bob Dole dies

Former Sen. Bob Dole in 2019. Photo: Tom Brenner/Getty Images

Former Kansas Sen. Bob Dole passed away Sunday morning at the age of 98, the Elizabeth Dole Foundation announced in a statement.

Driving the news: Dole, a revered figure in U.S. politics and the Republican presidential nominee in 1996, served in the Senate for 27 years, including 11 years as GOP leader. Earlier this year he revealed he had been diagnosed with stage 4 lung cancer.

Movie theaters go out of style

Illustration: Sarah Grillo/Axios

Vaccination rates are going up, people are going out to restaurants again — although the new COVID variant may get in the way — but they still aren't rushing back to the movies.

By the numbers: Some 49% of pre-pandemic moviegoers are no longer hitting theaters, according to a study from the film research company The Quorum, as reported by the New York Times.