Visits to the hospital are never fun, and they’re rarely straightforward.
But for some residents of eastern and central Maine who have a medical emergency — a broken leg, an allergic reaction, chest pain — seeking help is about to get more complicated.
It could cost more, too.
Starting early this year, many doctors who staff hospitals in Blue Hill, Ellsworth, Pittsfield and Waterville will no longer work for the hospitals themselves or its parent organization, Northern Light Health. Instead, they’ll work for a company based more than 1,000 miles away. TeamHealth, a physician staffing firm headquartered in Knoxville, Tennessee, has signed a contract with Northern Light to employ the emergency medicine and hospitalist doctors in those four hospitals.
That means patients who see those doctors would get a separate bill from TeamHealth, in addition to any others from Northern Light.
It also means patients who have confirmed that their local hospital accepts their insurance could be in for a shock: It’s not a given that TeamHealth will accept that insurance, too. If it doesn’t, patients could be stuck with a hefty bill.
Northern Light administrators say the new partnership will help the system — formerly called Eastern Maine Healthcare Systems — deliver stronger, more efficient hospital care. It comes as the organization has struggled to fill open positions at those small, regional health centers in recent years.
Yet at a time when Americans have grown increasingly wary of the steep costs and mysterious origins of medical bills, TeamHealth’s arrival could also put new, upward pressure on the price Mainers pay for a trip to the hospital.
In particular, if TeamHealth refuses to accept the prices offered by Maine patients’ health insurers, patients could be exposed to costly out-of-network bills.
A recent study from Yale University found that when TeamHealth and one of its competitors entered hospital emergency rooms between 2011 and 2015, a greater share of patients with health insurance accepted by the hospital ended up seeing physicians who were outside their insurance network.
The resulting bill from an unknown, out-of-network contractor could be more than double what the insurer was willing to pay, according to the Yale research. When that happens, patients may then be asked to cover the difference, and the so-called “surprise” or “balance” bill can reach hundreds or thousands of dollars.
Alternatively, if insurers agree to the steeper bill, they can pass that price on to patients through higher premiums.
While Northern Light administrators say that any insurance patients have used in the past should still work under the new partnership, a TeamHealth spokeswoman said the company may send out-of-network bills to Maine patients.
Members of Congress, meanwhile, have started considering solutions to the problem. In Maine, a law that took effect at the start of 2018 aims to protect patients from surprise, out-of-network bills. TeamHealth’s entrance into the four Northern Light hospitals could test the strength of the new law.
Some members of the health care industry have said out-of-network billing isn’t common in Maine, but it has been reported here. Ann Woloson, executive director of the Augusta-based advocacy group Consumers for Affordable Health Care, has heard from patients who thought a hospital and surgeon would take their insurance, for example, then were billed by an out-of-network anesthesiologist.
Besides the questions about TeamHealth’s billing, it’s still unclear what specific changes are coming to the staffing of the four hospitals under the for-profit contractor: Northern Light Blue Hill Hospital, Northern Light Maine Coast Hospital in Ellsworth, Northern Light Sebasticook Valley Hospital in Pittsfield and Northern Light Inland Hospital in Waterville.