In the United States, hospitals and physicians independently negotiate contracts with insurers. Therefore, a privately insured individual can be treated at an in-network hospital’s emergency department but receive a large unexpected bill from an out-of-network emergency physician working at that facility. Because patients do not choose their emergency physician, emergency physicians can remain out of network and charge high prices without losing patient volume. We illustrate that this strong outside option improves physicians’ bargaining power with insurers. We conclude by analyzing New York’s efforts to address out-of-network billing through binding arbitration between physicians and insurers over out-of-network payments. This intervention reduced out-of-network billing by 12.8 percentage points (88%).

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惊喜！美国紧急护理的网络外计费

在美国，医院和医生独立与保险公司谈判合同。因此，有私人保险的个人可以在网络内医院的急诊室接受治疗，但会收到在该机构工作的网络外急诊医生的大笔意外账单。由于患者不选择他们的急诊医生，急诊医生可以保持在网络之外并收取高昂的费用，而不会损失患者数量。我们说明这种强大的外部选择提高了医生与保险公司的议价能力。最后，我们分析了纽约通过医生和保险公司之间关于网络外支付的具有约束力的仲裁来解决网络外计费问题的努力。这种干预将网络外计费减少了 12.8 个百分点（88%）。