Taylor Davis racked up quite a bill after her recent visit to the ER. The only problem is that she didn’t see a doctor and didn’t receive any care. It’s a strange thing that happens all too often in the healthcare industry. Patients are billed despite receiving no treatment.
A Long Wait
Davis, of Georgia, went to Emory Decatur Hospital in July after suffering a head injury. She says she was made to sit in the waiting room for seven hours. After receiving no care, she left.
“I sat there for seven hours,” she told a local news outlet. “There’s no way I should be sitting in an emergency room – an emergency room – for seven hours.”
That’s why she was so surprised to receive a bill from the hospital weeks later for $688.35.
“I didn’t get my vitals taken, nobody called my name,” Davis said. “I wasn’t seen at all.”
Davis originally thought she received the bill in error, so she contacted the hospital and was told she was charged an “emergency room visit fee.”
“[The employee] said it’s hospital protocol even if you’re just walking in and you’re not seen,” she said. “When you type in your social, that’s it. You’re going to get charged regardless.”
According to an email Davis received from the hospital, the facility said, “You are charged before you are seen. Not for being seen.”
Experts say this kind of charge is usually added to a person’s bill, so they may not notice it.
Davis was outraged and says she will think twice before seeking treatment at a hospital.
“I’m very reluctant to go to the hospital now. That’s kind of like the last resort now,” she said. “Seeing that they’re able to bill you for random things, it doesn’t make me want to go. So that’s not good.”
The hospital released a statement after the incident.
“Emory Healthcare takes all patient concerns seriously and appreciates this has been brought to our attention,” the statement said. “Our teams are currently looking into this matter and will follow up directly with the individual.”
Davis isn’t alone. Surprise bills like these could keep others in need of care from visiting the hospital.
Studies show that about 1 in 5 emergency visits and 1 in 6 inpatient admissions will trigger a surprise bill.
These bills can be for all types of care. Patients with insurance may see a surprise bill if they visit a facility that’s outside of their network. Even if they stick to an in-network facility, there’s still a chance they will be seen by a doctor that hasn’t signed onto the insurer’s network. In many cases, patients are then forced to pay these bills out-of-pocket.
A new law that’s set to go into effect on January 1, 2022, could do away with surprise billing all together.
The No Surprises Act forbids insurers and providers from dropping surprise bills onto patients.
Instead, patients will be only charged what they would’ve paid if their care had been performed in-network. The insurer and provider will then have to figure out how to settle the difference.
After that, the insurer and provider will enter what’s known as “baseball-style” arbitration, in which both parties will present an offer and the arbitrator will pick one. The loser also must cover the cost of arbitration, which the rule sets for next year as $200 to $500. The law also gives insurers and providers 30 days to sort out these discrepancies. The rule says the arbitrator should pick the amount closest to the median in-network rate negotiated by insurers for that type of care.
The government is trying to protect ordinary consumers and patients from surprise bills, but industry leaders are pushing back against the idea. Some argue it could lead to higher insurance premiums for patients, but others say it may actually slow premium growth.
Katie Keith, a research faculty member at the Center on Health Insurance Reforms at Georgetown University, says that the law would “put a thumb on the scale” to discourage settlements at amounts higher than most insurers generally pay for in-network care.
The American Medical Association called the law “an undeserved gift to the insurance industry,” while the American College of Radiology said it “does not reflect real-world payment rates” and warned that it could “cause large imaging cuts and reduce patient access to care.”
It’s unclear how the new law will ultimately affect insurance prices and premiums for patients. At least people like Davis won’t be on the hook for surprise bills.