Emergency room doctors: not covered by your insurer?

  Another consequence of Obamacare--in addition to being booted off your insurance, rising overall rates, limited doctor choices and higher deductibles--appears to be developing in hospital emergency.
  You may have noticed more doctors are joining hospital staffs, something they've had to do in response to being squeezed out of private practice by onerous regulations. One doctor told me then because of insurance, he will now be required to hire 9 people to run his office as opposed to the 2 he would normally hire.
  Regulations have increased many times over; indeed, many doctors are looking at retirement rather than deal with the new coding, described here:

The other complicated “innovation” of Obamacare is ICD 10 coding system.  This new coding system replaces ICD-9. It has increased the number of codes from 18,000 to 68,000 for coding in-patient and out-patient care. Effective implementation of these codes will be very difficult.
The implementation of these two “innovations” will add billions of dollars to the cost of healthcare.

  So that increase from 18,000 to 68,000 will surely put some doctors out of business.
  Now we learn that emergency room doctors are quite often private contractors; thus, even though the hospital you frantically ran into for treatment may be in your network, the doctor who treats you may not be. NYT:

But even the most basic visits with emergency room physicians and other doctors called in to consult are increasingly leaving patients with hefty bills: More and more, doctors who work in emergency rooms are private contractors who are out of network or do not accept any insurance plans.

When legislators in Texas demanded some data from insurers last year, they learned that up to half of the hospitals that participated with UnitedHealthcare, Humana and Blue Cross-Blue Shield — Texas’s three biggest insurers — had no in-network emergency room doctors. Out-of-network payments to emergency room physicians accounted for 40 to 70 percent of the money spent on emergency care at in-network hospitals, researchers with the Center for Public Policy Priorities in Austin found.

  [SNIP] This is a result of Obamacare, according to the NYT. Up to 65% of hospitals employ contracted ER physicians:

   Regulations created by the Affordable Care Act specify that insurers must use the best-paying among three methods for reimbursing out-of-network physicians dispensing emergency care: pay the Medicare rate; pay the median in-network amount for the service; or apply the usual formula they use to determine out-of-network reimbursement, which often depends on “usual and customary rates” in the area.

But in most states, doctors can then bill patients for the difference between their charge and what the insurer paid.

  In fact:

Just because a hospital in "in-network" with your insurance, that doesn't mean the emergency room doctor is. In fact, there's a good chance that an emergency room doctor doesn't take any insurance at all, and that could lead to big out-of-pocket expenses for you.

  The solution? Yeah, no:

There isn't much you can do, if you are in a life/death emergency, you should go to the closest emergency room.  But if it is not life/death, ask the emergency room staff if the physician on duty takes your insurance, if not, assess if you can go elsewhere.

  It's called "balance billing." How are the fees determined?

"UnitedHealthcare uses rates determined by Medicare Centers for Medicare and Medicaid (CMS) Fee Schedules to process claims," said Kim Whitaker, spokeswoman for UnitedHealthcare.

<   According to Physicians' Weekly:

Many health insurers are shrinking their networks for health insurance exchange programs in an attempt to secure deeper discounts from participating hospitals. Consequently, the number of out-of-network hospitals is likely to rise, and the number of payment disputes for these emergency services will increase. One of the lesser known provisions of the ACA attempted to establish payment metrics for services provided in out-of- network hospital EDs.

  A list of states that regulate balance billing is here. Ohio is not one of them.
  You'll be happy to know that the ACA set limits on the amounts consumers have to pay....for in-network care.

And the law's new limits on how much consumers must pay out of pocket — $6,350 for an individual and $12,700 for a family this year — apply only to in-network care.

  It appears Medicare and Medicaid patients are exempt from the billing:

Medicare bans balanced billing for providers who accept Medicare payments, yet even Medicare patients routinely receive "You Owe Us This Much More" bills in the mail, even when the debt is not truly owed. Those "nickel and dime" balanced billing debts, (wherein a patient is only charged a few dollars more than their actual co-pay), are routinely paid by the patient who doesn't take the time to calculate what his or her share really should be. Across the country, those seemingly insignificant amounts add up to billions of dollars in revenue that health care providers receive but are not entitled to.

Then there are the providers who see a patient in the emergency room and ask the injured or ill patient to sign a document that states that the patient will pay the medical providers their full fee, regardless of what the insurance pays. This creates, in effect, a new contract that supersedes the insurance policy, and it changes everything for the patient.

  This article advises:

It's just so easy to pay a bill without first investigating it, especially if the overage being billed is small enough that we don't readily notice. We should all check our bills with an eagle eye and compare what should be paid with what the provider is asking us to pay.

UPDATE:
  So basically this problem is because 1) emergency room services are contracted out to ER doctors, not all of whom work with the insurance companies the hospital uses 2) somebody's got to pay the ER doctors, who donate a lot of services to people who don't have any insurance.
  IOW, YOU, the one who works, has insurance, responsible citizen, have to pay for those who don't or won't pay, an example being all the illegals in California.
  Here:

Emergency care providers have a burden that comes with a disproportionate responsibility for the care of the under- and uninsured, and they cannot shoulder this burden if they are unable to receive sufficient and fair payment for the care of those who are insured.  The emergency care safety net is already unraveling, and a prohibition against balance billing with no requirement that health plans pay fairly is a prescription for the failure of this safety net.

  One wonders if we could do anything else to destroy the best health care system in the world.