Research

Seven in 10 Americans oppose health plan efforts to deny payments for ER visits

Seventy percent of Americans oppose efforts by insurance companies to deny payment for emergency visits when patients believe they are having medical emergencies, but after examination are diagnosed with non-urgent medical conditions, according to the results of a new poll conducted by Harris Interactive on behalf of the American College of Emergency Physicians (ACEP). In addition, 85 percent of respondents with regular medical providers who sought emergency care said they could not have waited to see their regular providers.

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“Many health plans and state Medicaid offices increasingly want to reduce costs by refusing or lowering payments for emergency room care, despite emergency care being only 2 percent of the nation’s health care dollar,” said David Seaberg, MD, FACEP, president of ACEP. “This poll shows strong public support for emergency care and for a federal law already in place that protects coverage of ER visits. It also shows that people are seeking emergency care because they believe they are having medical emergencies.”
The federal law that protects coverage of emergency care is the prudent layperson standard, which requires health plans to cover visits to emergency departments based on an average person’s belief that he or she may be suffering a medical emergency due to the person’s symptoms, not the final diagnosis. It was designed to protect patients who experience the symptoms of a medical emergency but who, after a medical examination and testing by a trained professional, are diagnosed with an acute care or non-emergent medical condition. It was included in the national health care reform law, the Patient Protection and Affordable Care Act in 2010 and the Medicare Balanced Budget Act of 1997.

The Emergency Medicine Action Fund is a coalition of organisations, practitioners, and stakeholders created to respond to the challenge of health care reform across the acute care continuum. Its contributors gave $100,000 to the Washington Chapter of ACEP for legal efforts and another $55,000 for policy analysis and health care research showing the HCA pro-posal would not have been safe for patients with a large number of urgent or emergent conditions.

 

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