“Early last year, executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room. The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare was something hundreds of other hospitals across the country had done,” Julie Creswell, Reed Abelson and Margot Sanger-Katz write at The New York Times. “That’s when the trouble began. Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code. Continue reading the main story Photo A small, rural hospital in Washington State, Newport Hospital and Health Services, outsourced its emergency room, as many hospitals have. Soon it started hearing from patients confused by getting large bills from the E.R. doctors. On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649. ‘The billing scenario, that was the real fiasco and caught us off guard,’ said Tom Wilbur, the chief executive of Newport Hospital. ‘Hindsight being 20/20, we never would have done that.’ Faced with angry patients, the hospital took back control of its coding and billing.” Julie Creswell, Reed Abelson and Margot Sanger-Katz,“The Company Behind Many Surprise Emergency Room Bills,” The New York Times.