by
Thomas Dworetzky, Contributing Reporter | June 14, 2018
The insurer then has 45 days to handle a provider's claim and offer “a reasonable reimbursement” for the unanticipated out-of-network care – which a provider can decline and then either negotiate or arbitrate a final binding decision – with arbitration costs evenly split between provider and carrier.
As a 2017
report in JAMA by Johns Hopkins researchers noted, most patients do not actually choose doctors with the highest markups, like anesthesiologists, emergency medicine doctors, and diagnostic radiologists – allowing them no opportunity to anticipate how high their bills will be.
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"The doctors with the highest markups are often the ones that patients don't actually choose," senior author Gerard F. Anderson, Ph.D., a professor in the Department of Health Policy and Management at the Bloomberg School, said at the time. "Many people are shocked two weeks or two months later when they get a bill from a doctor they didn't really meet and no one told them what the exam would cost, and later they discover the price is outrageous. But this is happening all the time."
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