Listen, there's no way we're getting through an article about emergency department doctors without bringing up the mid-'90s hit medical drama "ER." And instead of trying to bury some reference to Carol Hathaway's cold feet in our third paragraph or injecting Carter's fancy-rich childhood into a conclusion, let's just acknowledge right now that from this point forward, you're free to fill in "Doug Ross" in your own mind whenever we reference "emergency room doctors/providers."
Good, that's out of the way. So now let's cut to the answer: Nope, lots of emergency room providers aren't actually working for the hospital at which they practice. And if you're thinking, "harrumph, that's not like a television drama at all," be assured that it used to be much more common for hospitals to use their own staff for emergency medicine. That was no doubt less confusing to the consumer, because it meant that the physicians, specialists and the like wouldn't bill patients separately; their services would be part of the overall visit-to-the-ER bill.
But with emergency medicine emerging as its own field, various staffing groups actually contract out their emergency practitioners to hospitals. These days, an estimated 65 percent of hospitals contract out their emergency providers [source: Rosenthal]. The big issue with this contracted staffing is in that pesky bill the patient receives after an ER visit, because it could very well mean you're getting charged way more than you would expect. But why would a staff doc have any different charge than a contracted doc?
Welcome to the wonderful world of health insurance. More to the point, welcome to the aggravating world of in- and out-of-network providers. Now bear in mind that lots of insurance plans will cover an entire hospital as in-network. That means that the savviest among us (or at least those with the least life-threatening problems) might have time to make sure they're going to an in-network hospital before they rush to the ER. All good, you'd think. Go to the ER in your network, and you can rest assured your insurance is covering your costs as much as your plan allows.
Unless, of course, the doctor you see in that in-network ER is not part of your network. And because providers might not be employed by the hospital, they don't have to be. A contracted doc might not be part of your plan's in-network coverage or — worse — might not take any insurance at all. The result is that a contracted ER doc might be able to charge you the balance of the bill, if your insurance company is not paying him or her. If your health plan only pays for, say, the cast that the doc puts on your arm, the doctor now gets to charge you directly for the cost of her or his services.
Controversial, as you can imagine, and the Affordable Care Act has done a few things to try to prevent (or offset) the costs, including making sure your insurance plan is paying the greatest cost possible to the provider [source: FamiliesUSA]. In which case, Doug Ross can rest easy.
- Doherty, Bob. "There is no excuse for physicians to take advantage of vulnerable patients." KevinMD.com. Oct. 18, 2014. (April 9, 2015) http://www.kevinmd.com/blog/2014/10/excuse-physicians-take-advantage-vulnerable-patients.html
- Families USA. "The Affordable Care Act: Patients' Bill of Rights and Other Protections." April 2011. (April 9, 2015) http://familiesusa.org/sites/default/files/product_documents/Patients-Bill-of-Rights.pdf
- Feibel, Carrie. "Surprise Medical Bills: ER Is In Network, But Doctor Isn't." National Public Radio. Nov. 11, 2014. (April 9, 2015) http://medical-malpractice.lawyers.com/the-doctor-is-in-how-doctors-work-with-hospitals.html
- Pearlstein, Steven. "Tendon surgery sheds light on the lack of clarity in some out-of-network pricing." The Washington Post. Oct. 10, 2014. (April 9, 2015) http://www.washingtonpost.com/business/tendon-surgery-sheds-light-on-the-lack-of-clarity-in-some-out-of-network-pricing/2014/10/10/a2646334-50ad-11e4-8c24-487e92bc997b_story.html
- Pogue, Stacey. "Surprise Medical Bills Take Advantage of Texans: Little-known practice creates a 'second-emergency' for ER patients." Center for Public Policy Priorities. Sept. 15, 2014. (April 9, 2015) http://forabettertexas.org/images/HC_2014_09_PP_BalanceBilling.pdf
- Rosenthal, Elisabeth. "Costs Can Go Up Fast When E.R. Is in Network but the Doctors Are Not." The New York Times. Sept. 28, 2014. (April 9, 2015) http://www.nytimes.com/2014/09/29/us/costs-can-go-up-fast-when-er-is-in-network-but-the-doctors-are-not.html