Late-night ER fee dropped

The union called for refunds.

"It's good that when this indefensible practice was called to the public's attention that Beth Israel stopped it," Mike Fadel, executive vice president of Local 1199 of the Service Employees International Union said in a statement e-mailed to the Globe. "These fees never should have been charged in the first place, so if they want to do the right thing, they now need to refund the fees to the patients who were charged."

Patients with insurance might not have seen the fee. The government Medicare and Medicaid programs do not pay doctors who bill such a fee, nor do private insurers Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, Tufts Health Plan, and Aetna, spokesmen said today. If insurers reject the fees, the patient cannot be charged under a state law that forbids what is called balance billing.

The few patients without insurance who pay their own bills might have been charged what would represent less than 5 percent of a total charge for emergency care, Wolfe said. David McKenzie, reimbursement director of the American College of Emergency Physicians, said the late-night fee is commonly billed throughout the country, although the group does not track such claims. Doctors at none of the other major Boston hospitals charge the fee.

Wolfe compared the fees to different rates that nurses are paid for working late shifts, defending them as a way to reward people willing to work overnight, especially at a time when emergency physicians are in short supply.

"It ends up being a morale issue to support the people that are doing the work," he said.