Willing Healthcare Providers Seek Fair In-Network Contracts

One of the most critical issues impacting the healthcare of North Texans is timely access to it. In fact, the American College of Emergency Physicians gave Texas an “F” in access to emergency care in their 2014 Report Card. Unethical business practices and actions taken by health insurance companies are keeping Texans from being able to choose expeditious and cost-effective emergency services.

Independent freestanding ERs offer a high quality, fast, and cost-effective alternative for acute, unscheduled care. Yet, there is a coordinated effort by health insurers to keep these facilities out of their contracted health networks. As an owner of both freestanding ERs and urgent care facilities in the Dallas-Fort Worth area, I am familiar with in-network negotiations and have successfully secured multiple in-network contracts for my urgent care centers. However in my opinion, when it comes to freestanding ERs, insurance companies have not acted in good faith.

Being an in-network provider helps consumers anticipate expected medical bills, and have confidence in the options available to them in the event of an emergency. Even though independent freestanding ERs are a growing healthcare delivery model in Texas, insurance companies have shown resistance to working with them.

North Texas is home to 40 independent freestanding ERs that provide a less expensive alternative to more than 100 hospital-owned and operated ERs in the area. My experience attempting to become an in-network provider for my freestanding ERs was time consuming—lasting two years—and, ultimately, fruitless. Currently, none of my freestanding ERs are in-network, although by law, we must see and treat all patients with an emergency. As a physician and ethical business woman, it was a frustrating experience to negotiate a reasonable payment rate on behalf of our patients.

For the few companies willing to communicate with me beyond an initial email, they refused in-person meetings and full disclosure of methodologies, and attempted to lock me in at a low rate that would be unsustainable for any viable medical practice. To me, their final goal was to set a low payment rate, and then drive up deductibles and patient responsibility–essentially turning my facilities into a credit card system for the insurance companies.

Unfortunately, most freestanding ER operators have had a similar experience. A recent poll of freestanding ERs in Texas found that 64 percent had not been contacted by a health plan to contract, despite the operators’ repeated attempts to do so. Forty-five percent said their inability to obtain in-network status was due to unreasonably low offers for contract rates, which were too low to allow them to stay in business. In these instances, the only reasonable option for healthcare providers is to opt out. If we choose to accept the ridiculously low payment rates, we won’t be able to sustain our business. Either way, Texans lose.

As an individual insurance policyholder, I experience the same frustration when I question my medical bills. Insurance companies are attempting to obscure methods for determining usual and customary rates of coverage for patients. In Texas, narrow networks are not due to an insufficient number of healthcare providers. Many providers are lined up waiting for a reasonable offer from health insurance companies. If insurers want enrollees to have timely access to care, they would allow freestanding ERs to join their networks and offer reasonable payment. We stand by ready and willing to do the job.

Dr. Carrie de Moor is president and CEO of Frisco-based Code 3 Emergency Physicians and chairman of the American College of Emergency Physicians’ Freestanding Emergency Centers Section.

Posted in Expert Opinions.