You signed up for insurance, pay health insurance premiums on time, and believe that you have good emergency care coverage. Unfortunately, that is less often becoming the case. According to a new nationwide poll of over 1,900 emergency physicians, most patients do not understand what their policies cover for emergency care. According to the doctors, health insurers mislead patients by offering “affordable” premiums for policies that cover very little. “Just because you have health insurance doesn’t mean you have [emergency] coverage,” Jay Kaplan, M.D., president of the medical specialty society, said in an announcement.
Some people arrive at emergency rooms with $400 copays. “Patients should not be punished financially for having emergencies or discouraged from seeking medical attention when they are sick or injured. No plan is affordable if it abandons you when you need it most,” Kaplan said. The poll also revealed that many patients are putting off medical treatment because of high out of pocket costs.
Problems are only going to get worse as patients see their plans restricted to ever-narrowing networks of providers, making it more likely that they will require emergency care at an out of network facility. The president of the society did not mince words, reporting, “Insurance companies are exploiting federal law to reduce coverage for emergency care knowing emergency departments have a federal mandate to care for all patients, regardless of their ability to pay.”
For instance, there are multiple hospitals in the New Brunswick area, and, depending on your health insurance, you may only be “in network” with one of them. If there is an emergency, and you go to an out of network hospital, you may be responsible for substantial out of pocket costs.
Other results from the emergency care coverage poll include:
- Sixty-two percent of ER doctors polled say most health insurance plans provide less than adequate coverage for emergency care visits.
- More than 60 percent of ER docs have had difficulty in the past year finding in-network specialists to care for patients. A quarter of them say they face this problem every day.
- Ninety-one percent believe it will be even more difficult to find specialists and follow-up care for their patients due to a new federal rule that exempts health insurers from meeting minimum standards to ensure adequate networks.