Congressman Lloyd Doggett, a Democrat from Texas, introduced legislation last year to tackle the practice nationwide, but he said he experienced “a healthy dose of indifference” from his colleagues on the Ways and Means committee. Mr. Doggett had heard complaints of surprise bills from constituents, and it turns out that the new study found that Texas is a hot spot for the practice. Mr. Doggett said he would introduce the legislation again next year. “I think that there’s got to be a way to get consumers out of this trap,” he said.  President Obama included proposals to limit out-of-network emergency room bills in his budget proposal, and recent regulations have made it more difficult for doctors to collect certain bills, though those rules are being fought in court by physicians. The acting administrator for the Centers for Medicare and Medicaid Services has said that surprise bills are a policy priority for him.  The data in the study come from one large commercial insurer, but the researchers agreed not to name it in exchange for access. Mr. Cooper said there was only a little difference in the share of surprise bills in places where the insurance company had a lot of customers, compared with those where it did less business.  Emergency room doctors criticized the study’s findings and were quick to blame the insurers. The American College of Emergency Physicians, the medical society that represents the doctors, said patients are much less likely to face large unexpected bills than the study suggested, citing an analysis the group did in Florida of patients who were “balance billed,” or asked to make up the difference between what the insurer pays and what the doctor bills.  “Our balance bills are less than a couple of hundred dollars, on average,” said Dr. Rebecca Parker, the group’s president. She said that most doctors want to be included in networks but that they are not being offered reasonable fees.  “This is insurance company bad behavior,” said Dr. Parker, whose group this week put out a parody video that accuses the insurers of paying too little for their work.  Insurance companies like to blame the physicians, arguing that while they can reach a deal with the hospitals, there are many doctors who refuse to be part of the network they offer under a plan.  And the insurers argue hospitals have a responsibility to make sure the outside doctors they use to staff their emergency rooms sign contracts with the same health plans they do. “This would go a long way to reduce and prevent consumers from receiving a big surprise balance bill,” Kristine Grow, a spokeswoman for America’s Health Insurance Plans, a trade group, said in an email. The new paper’s authors agree.  When Mr. Moore received his doctor’s bill, he tried appealing the charge to his insurance company. “We understand that you went to a preferred provider facility and did not have a choice of the emergency room physician who treated you,” his insurer wrote back — but denied the claim. Then he went to the private practice that had sent him the bill. It was willing to negotiate.  “They knocked off half the bill,” he said. “Which is great. It’s like, would you rather get punched four times or two times? I guess two times is better.”
Patients who go to hospitals covered by their medical plans often receive a bill from a doctor who was not in the insurer’s network, a study finds.