Envision Healthcare strikes up in-network payer contracts amid scrutiny over surprise billing

Envision Healthcare, the physician staffing company with a reputation for sending patients big surprise medical bills, is entering a multiyear contract to provide Horizon Blue Cross and Blue Shield’s commercial, individual and Medicare members access to Envision doctors across New Jersey.

Nashville-based Envision earlier this month struck up a national in-network contract with UnitedHealthcare after a months-long contract dispute over Envision’s high charges for emergency department services. And in November, Envision entered a contract with Cigna Corp.’s Arizona subsidiary.

Envision’s push to bring the majority of its revenue in-network comes amid growing federal and state scrutiny over surprise medical billing, which can occur when a patient unknowingly visits a doctor or healthcare facility that does not contract with the patient’s health insurer.

The company set a goal in February 2017 to move all of its revenue in-network. At the time, Envision received about $1 billion in revenue from out-of-network claims. But the company said earlier this month that more than 90% of its business now comes from treating patients who are in-network.

Envision was the subject of a 2017 Yale University study that found that hospitals outsourcing their emergency department operations to Envision unit EmCare experienced increases in the rates of out-of-network bills, tests ordered and patients admitted to the ER. The study prompted Sen. Claire McCaskill (D-Mo.) to request information on Envision’s billing practices.

The company employs more than 25,000 clinicians who staff various hospital departments, including anesthesia, pain management, emergency medicine, hospital medicine, and radiology.

It was bought by private equity firm KKR in October for $9.9 billion. Envision CEO Christopher Holden told Modern Healthcare in October that going private would protect the company from the sensitivities of Wall Street analysts, who don’t appreciate the company’s transformational moves when they don’t pay off in the short term.