“Surprise” Gaps in Health Insurance Coverage Need Solutions

Managed Care Weekly Digest

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- "Insurance companies have been taking gross advantage of patients and emergency medical providers for years and with greater frequency since the enactment of the Patient Protection and Affordable Care Act, by raising deductibles and arbitrarily slashing payments to physicians by as much as 70 percent. They are able to do so because the Emergency Medical Treatment and Labor Act (EMTALA) requires 100 percent of emergency patients be seen, regardless of insurance or ability to pay," wrote Rebecca Parker, MD, FACEP, president of the American College of Emergency Physicians (ACEP) HYPERLINK "http://www.nejm.org/doi/full/10.1056/NEJMc1700368" nin a letter published in the New England Journal of Medicine (NEJM) (see also American College of Emergency Physicians ACEP).

In her letter, Dr. Parker pokes holes at a recent NEJM perspective article about out-of-network billing, saying it "fails to provide a fair assessment of so-called 'surprise billing' in emergency care," and calls into question the reliability of the data used by Yale University researchers Zack Cooper, PhD., and Fiona Scott-Morton, PhD in their Nov. 17th article [Out-of-Network Emergency-Physician Bills - An Unwelcome Surprise].

"As soon as we saw the outrageous claim that patients received thousands of dollars in balance bills from emergency physicians we knew we had to respond strongly and quickly" said Dr. Parker. "It's simply not true. We know that as an industry the balance bills of emergency physicians are less than $200 on average. Our state-based data demonstrates this and sets the record straight."

Additionally, an analysis of out-of-network emergency billing in Florida found the practice of balance billing to be rare, according to Dr. Parker.

"The true story is that our patients are being saddled with high-deductible plans that cover very little," said Dr. Parker. "Emergency physicians and ACEP have a long history of standing up for emergency patients when the insurance companies default on their moral obligations to cover patients in their greatest hours of need. From the anti-dumping legislation in the 1980s known as EMTALA to the HMO era of the 1990s and prudent layperson emergency physicians are speaking up for their patients and against the abuses of the for profit insurance industry."

The solution to out-of-network billing, according to Dr. Parker, is the newly implemented Connecticut law that uses an independent and transparent charge database.

"Emergency physicians are calling for transparency by insurance companies and use of independent databases, such as Fair Health (HYPERLINK "http://www.fairhealth.org/" nwww.fairhealth.org]," said Dr. Parker. "We've made it clear that patients need affordable health care that covers them when they need it most - during an emergency. Our patients deserve fair coverage. Their lives depend on it."

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.

Keywords for this news article include: Legal Issues, Health Insurance, American College of Emergency Physicians ACEP, American College of Emergency Physicians (ACEP).