Ho says laws in various states and on the federal level are under consideration for addressing the issue, but that such regulations require enforcement and should apply to everyone. One example is in Texas, which passed legislation that required facilities to disclose whether they were in-network or outside of it.

“They found out that even though they passed this, most of the facilities actually weren’t following the regulation and were still misleading the patient,” said Ho. “Texas just passed another legislation this year that said that a patient can’t be caught in the middle. They don’t have to pay the surprise medical bill. It’s up to the insurer and the provider to duke it out in terms of who pays what. The problem is that if your insurance from your employer is covered under ERISA (Employee Retirement Income Security Act), that state law doesn’t apply to you. If you work for a larger employer that is self-insured, you are still going to get stuck with a surprise medical bill.”


The Blue Cross Blue Shield Alliance for Health Research provides access to HIPAA-compliant data from Blue Cross Blue Shield Axis, the largest collection of commercial insurance claims, medical professional and cost of care information, through a secure data portal.

The study is titled, Free-standing Emergency Department Entry and Market-Level Spending on Emergency Care.

The findings were published in the journal, Academic Emergency Medicine.

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