Envision is tackling surprise billing amid contract tensions

Surprise healthcare billing is an unpleasant reality for many Americans who receive care and are blindsided when the bill finally arrives. Even for those with healthcare insurance coverage, surprise billing can be financially devastating and frustrating.

In the case of one Texas man who experienced a heart attack, an out-of-network hospital charged him more than $100,000 after his insurance already paid more than $50,000 for his care. Patient stories like this shine a negative light on providers and have even sparked legislation to end the practice of surprise billing. But some healthcare stakeholders caught in the middle of the outcry are also attempting to limit the harm to patients and consumers.

Envision Healthcare, a physician-led services and post-acute care company based in Nashville, Tennessee, has launched a campaign to better inform patients about billing practices and why they end up with surprise medical bills. The marketing campaign, which includes a video for consumers, also touches on how doctors and legislators can work to address the issue.

Envision also owns emergency department staffing company EmCare, which has been embroiled in accusations of high surprise billing. A 2017 study by Yale researchers revealed EmCare contracts with hospitals resulted in a 62 percent out-of-network billing rate.

“As one of America’s largest physician groups, Envision clinicians share the frustration our patients experience due to surprise coverage,” Christopher A. Holden, president and CEO of Envision, said in a statement. “Patients should focus on getting better, not worrying about unexpected bills resulting from surprise coverage and gaps in health insurance.”

The campaign is seemingly a response to the criticism Envision has received for its own billing practices with respect to out-of-network providers, according to some. In September, UnitedHealth Group recently signaled to Envision it may end its contracts and warned more than 250 hospitals it may drop Envision starting in 2019. UnitedHealth has struggled to come to emergency room service payment agreements with Envision, which has been accused of demanding exorbitant rates for ER physician services.

Envision sued UnitedHealthcare, but the case was dismissed in court in April. The company is reportedly being acquired by private equity firm KKR & Co. in a deal valued at nearly $5.6 billion.

Envision placed some of the blame for surprise bills on consumers on high deductible health insurance plans, the company stated in its marketing video.

Envision and EmCare are currently facing a class action lawsuit in Florida over its billing practices for emergency medical services rendered.

The company’s new commitments to end surprise billing include a strategic commitment to use the in-network status whenever possible; statutory clarity around payment resolution at local and federal levels; a minimum benefit standard for safety net services, such as emergency care; and appropriate use of an independent and transparent charge database.

Both the minimum benefit standard and independent database are legislative solutions that Envision supports as mandatory for insurance providers.