Dr. Frey added that there is a transparency problem in the health insurance industry that has led to gross misperceptions regarding out-of-network billing. If a patient purchases an insurance plan with a narrow network, they generally will end up out-of-network in an emergency , through no fault of their own, because they have a condition that by its nature demands a very specialized level of care, such as a stroke, heart attack, and trauma.
Emergency physician in Nevada have supported solutions to the “surprise billing” problem by endorsing Nevada Senate Bill 289 that would require certain policies of health insurance to cover services provide by out-of-network physicians.
“SB 289 brings us closer to a balanced and transparent solution that is patient-centered than ever before, said Dr. Frey. “It will unburden our patients from uncertainty, and provides transparent protections that keep patients from being placed between a rock and a hard place.”
Emergency physicians are calling for transparency by insurance companies and use of independent databases, such as Fair Health. Payments for emergency visits should be based on usual and customary charges, rather than arbitrary rates set by the insurance industry that don’t even cover the costs of care and sack patients with unfair bills. The insurance companies are exploiting federal law (EMTALA) that mandates that hospital emergency departments see all patients, regardless of their ability to pay.
“What’s potentially happening in Nevada threatens patients in other states as well,” said Rebecca Parker, MD, FACEP, president of ACEP. “Health insurance companies have a long history of denying care for emergency patients. They are misleading patients by selling so-called ‘affordable’ policies that cover very little, then blaming medical providers for charges’ State and federal policymakers need to ensure that health insurance plans provide adequate rosters of physicians and fair payment for emergency services.”
Dr. Parker said that health insurance companies used to deny emergency claims based on final diagnoses, instead of symptoms. In other words, if chest pain brought a patient to the emergency department, and the patient turned out to have indigestion, the insurance company refused to cover the visit. Emergency physicians successfully fought back against these policies. Now, insurance companies are exploiting a federal law [EMTALA] mandating that hospital emergency departments see all patients, regardless of their ability to pay, and insurance companies are shifting more and more costs onto patients and medical providers.
ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.