Providers Exploit Arbitration, Consumers Pay the Price

By Lindsey Murtagh

The Conversation

The Conversation is an independent, nonprofit news organization offering insights and analysis from researchers and scientists to help readers navigate a complex world.

Picture a scenario where you are struck by a vehicle. An ambulance rushes you to the nearest medical facility. Your personal health insurance covers emergency services, yet the hospital is not within your insurance network.

Prior to 2022, receiving emergency treatment from an out-of-network hospital could result in an extra, sometimes substantial charge, in addition to what you owe as a copay, coinsurance, or deductible.

This situation often left patients facing unexpected and significant financial burdens. The issue arose from being treated at a facility or by a provider not covered under one’s insurance network.

Arbitration processes were intended to resolve disputes between providers and insurers over out-of-network charges. However, certain providers have increasingly manipulated this process, leading to consumers bearing the financial brunt.

These circumstances underscore the importance of being informed about your coverage and exploring how these arbitration practices affect healthcare costs.