Navigating Emergency Physician Group Bills: A Guide

Receiving a separate bill from an emergency physician group after visiting the emergency room can be confusing. This comprehensive guide breaks down why you receive these bills, how to understand them and tips for managing payment.

Why Am I Billed Separately for Emergency Physicians?

Emergency physician groups provide the doctors and medical professionals that staff hospital emergency departments However, they are usually separate legal entities from the hospitals themselves. This means the physician services are billed independently from the emergency room facility fees.

It is standard practice to receive a bill from both the hospital system for ER facility charges and the emergency physician group for professional services rendered. This separate billing occurs even if the emergency physician group has an exclusive contract with the hospital.

Some common emergency medicine physician groups include:

• Emergency Physicians Professional Association (EPPA)
• US Acute Care Solutions
• TeamHealth
• Envision Healthcare

What to Expect on Your Emergency Physician Bill

The emergency physician bill will look different and include unique coding from a standard hospital ER bill. Here is what to expect:

• The provider name will be the emergency physician group, not the hospital.

• Services will be billed under the group’s tax ID number.

• CPT codes starting with 992XX represent emergency department services. For example:

  • 99281 – Emergency department visit, problem of low severity
  • 99282 – Emergency department visit, problem of moderate severity
  • 99283 – Emergency department visit, problem of high severity

• Other CPT codes may be listed for specific procedures, treatments, or diagnostic services performed.

• The place of service will show as “emergency room” or “ER.”

• The charges will only be for physician services, not facility fees.

If the emergency doctor ordered imaging, labs, or other ancillary services, those will show as separate line items with additional billing entities.

Should I Wait to Pay Hospital Bills First?

You do not need to wait for the hospital ER bills to pay your emergency physician group. The physician group bills can be settled right away independently.

One strategy is to request an itemized bill from both the hospital and emergency physician group before paying. This allows you to closely review the charges from each entity.

Also keep in mind that hospital billing departments tend to be larger and may take longer to generate bills. The emergency physician groups usually send bills quicker.

Tips for Managing Emergency Physician Billing

Here are some key tips for managing bills from independent emergency physician groups:

• Check your EOBs – Any payments from your health insurance will be reflected on the Explanation of Benefits (EOBs). Review EOBs to understand what was covered and what you may still owe.

• Ask about discounts – Uninsured or underinsured patients may qualify for significant discounts on emergency physician services. Always ask if there are self-pay reductions or financial assistance policies.

• Set up payment plans – Reputable groups will work with you on installments if you cannot pay the balance in full. Payment plans help avoidcollections or legal action.

• Negotiate if overcharged – Review line items closely and negotiate if you feel you were excessively overcharged. Groups may be willing to remove or reduce unreasonable fees.

• Avoid surprise bills – In some cases, out-of-network emergency physicians may bill balances not covered by insurance through a practice called balance billing. Be aware of your rights in regards to state surprise billing laws.

Example Emergency Physician Group Bills

To provide more context, below are examples of what real-life emergency physician bills look like from major groups:

EPPA Billing Statement

EPPA (Emergency Physicians Professional Association) serves emergency departments in Iowa, Minnesota, North Dakota, Wisconsin and Wyoming. Their billing statements include:

• Itemized list of all CPT codes billed and their retail charges

• Dates and location of ER services

• Account number and total balance due

• Instructions for paying online, by phone, or mailing payment

View a Sample EPPA Bill

TeamHealth Billing Statement

TeamHealth provides physician staffing for ERs nationwide. Their billing statements contain:

• Patient and provider information

• Itemized services with CPT codes

• Column showing amount billed to insurance

• Column for patient responsibility

• Instructions for payment, financing, or questions

View a Sample TeamHealth Bill

US Acute Care Solutions Billing Statement

USACS services many freestanding ERs and hospital ERs around the country. Their statements list:

• Date of service and account number

• Itemized charges with CPT codes and retail pricing

• Columns showing insurance payments and adjustments

• Total balance due by patient

• Payment remittance section

View a Sample USACS Bill

Don’t Hesitate to Reach Out With Questions

Receiving a separate bill from emergency room physicians can be perplexing if you aren’t expecting it. But now that you know these billing practices, you can be better prepared.

Always reach out to the billing department with any questions or concerns. Most emergency physician groups have patient advocates ready to explain charges and help navigate payments. Don’t hesitate to speak up!