Split Between Insurance Giant, Physician Group Could Lead to More Surprise Medical Bills

A battle between a health insurance giant and a physician staffing firm could lead to a spike in the number of surprise medical bills sent to individuals visiting anesthesiologists, neonatologists, and obstetricians, according to a published report.

UnitedHealth Group has terminated an agreement with Mednax, which means doctors working for Mednax will be not in UnitedHealth’s network. UnitedHealth patients who are treated by Mednax doctors will not be covered for those treatments. The termination covers Mednax doctors in four states — Arkansas, Georgia, North Carolina, and South Carolina. Only North Carolina has a law limiting surprise billing to help protect patients.

Surprise billing has been a major issue for the healthcare industry. A surprise bill occurs when a patient goes to a hospital, usually for an emergency situation, and is treated by doctors who are not part of the patient’s insurance coverage. While the hospital may take the patient’s insurance, there might be certain doctors who are not part of that coverage. The patient then receives a unexpected bill from those physicians after he or she leaves the hospital. In many cases, a patient in an emergency is not in a position to check whether a doctor is part of his or her insurance plan and consider going to another facility. 

Many states have enacted laws aimed at fighting surprise billing, but progress has been slow and patients continue to receive bills for thousands of dollars or more.

UnitedHealth said it terminated its agreement with Mednax because its doctors charged as much as 60% more than other doctors in those states. The insurance company made offers to reduce the payment rate to Mednax doctors, but never received a counter-offer.

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