Out of Network Billing

There are state and federal advocacy resources available through this page only if you log on with your ACEP ID and password. More state advocacy information can also be provided if you contact Harry Monroe.

In recent years, a growing number of states have considered legislation that would regulate out-of-network reimbursement and balance billing. The issue has grown in importance as insurance companies have narrowed their networks, in the process reducing the contractual rates they are offering to physicians participating in their networks.

At the same time, insurance consumers have been facing heavier financial responsibility in the form of higher co-payments and deductibles imposed under their insurance plans, leaving them often surprised at higher than expected bills for which they erroneously attribute responsibility to their health care provider. This is especially true in the hospital-based setting in general and in emergency medicine in particular. Insurance companies are seeking state legislative solutions to deny out-of-network physicians any recourse other than to accept payments unilaterally and arbitrarily chosen by the insurers as payment in full.

The resources on this page are designed to assist members dealing with state and federal legislative efforts to restrict the ability of out-of-network emergency physicians to receive fair payment for the care provided to patients.

Want to get involved? Group leaders are encouraged to sign a pledge form that their physician group is committed to these best practices in contracting to ensure the best interests of our patients. The demonstrated commitment and amount of emergency visits encountered will help show lawmakers that the payers are the problem - not us! 

Learn more about ACEP's advocacy work on this issue

Recent Op-Ed: Patients Should Count More Than Profits


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