It is a dirty little secret that keeps coming out more and more these days. It is the practice of outrageous “trauma fees” and other unexpected, inflated charges presented to patients who wind up in emergency rooms. It is yet one more aspect of America’s unique and dysfunctional health care “system” that is at once the least effective and the most expensive in the industrialized world.

The primary reason that patients receive these type of “surprise bills” is because of hospitals that outsource emergency room services to companies that are focused on maximizing profits while delivering as little as possible. It is sometimes also known as “out-of-network billing.”

Here is an example of out it works: someone gets a broken arm or leg and travels to an emergency room of a hospital where they believe they have coverage. However, unknown to the patient, the attending physician may actually be a contractor from a company that is not within his or her insurer’s network. As a result, the patient winds up being billed by the contractor – and the fees can be several times what the hospital would normally charge.

One of the more egregious offenders in what can only be described as a “scam” of monumental proportions is a management company known as EmCare, a division of Envision Healthcare. Last year, Forbes published a story highlighting the problem. A Tampa, Florida man was taken via ambulance to an emergency room at nearby Trinity Hospital. What he did not know was that the physician who treated him was not employed by Trinity, but by EmCare. As a result, he received an unexpected bill for over $2250.

According to a current class-action lawsuit, Envision has engaged in a “…deceptive and unlawful corporate scheme…[in which] physicians hide behind the veil of the hospital’s network.” The Forbes piece reports that critics of Envision have described the company’s practices as “U.S. healthcare at its ugliest.”

Other stories about the practice of outsourcing medical personnel have been published on Vox, which has been shining a spotlight on the issue. One article, part of a series that has been exposing secret emergency room fees, was about a couple from South Korea who had come to the U.S. with their infant son as tourists. When the couple’s eight-month-old son fell from the bed and hit his head, they took him to Zuckerberg San Francisco General Hospital to have him examined. Fortunately, the child suffered nothing more than superficial bruising. He was given formula and discharged a few hours later. When the family returned to South Korea, however, they received a bill for that formula in the amount of $18,000.

That is just the tip of the iceberg. Over the course of its investigation, Vox uncovered “trauma fees” of as much as $50,000 and more. Patients also received bills for other “outsourced” services, including x-rays and anesthesia – all of which are substantially padded. Most of these “fees” did not even exist 20 years ago.

The good news is that increasing consumer outrage and growing concern among emergency room doctors has finally gotten the attention of lawmakers on Capitol Hill. Senators Maggie Hassan (D-NH) and Bill Cassidy (R-LA) have introduced bills that would address the issue and at least require more transparency by medical “management” companies like Envision. At the same time, the American College of Emergency Physicians has come up with a proposal that they plan to present to Congress.

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K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.