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ER Doctors: Patients Stuck With Bill As Insurance Companies Cut Coverage

Published: Friday, May 13, 2016 - 4:02pm
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Emergency room doctors are not happy with insurance companies. That’s the result of a new survey from the American College of Emergency Physicians.

They survey got responses form 1,924 ER doctors in all 50 states, and nine in 10 of those surveyed say health insurance companies are short-changing patients by offering what they call “affordable” policies that end up sticking the patient with a big bill.

“Patients can’t choose when and where they’ll … need emergency care and so they shouldn’t be punished for having emergencies,” said Dr. Donald Lauer, president of the Arizona College of Emergency Physicians, the state chapter of the national group that conducted the survey.

The survey also found that 80 percent of emergency physicians surveyed said insurance companies have reduced the amount they reimburse for emergency care. Eight in 10 doctors surveyed said patients sacrifice care because of out-of-pocket costs.

“We’re going to see everybody,” Lauer said. “In the emergency department, we see everybody, regardless of their ability to pay.”

According to Lauer, there’s definitely an economic impact on doctors and hospitals.

“It’s very hard for patients to pay these bills. So, what often happens is we don’t get paid, the hospital doesn’t get paid,” he said.

He said, what happens is someone will go to a hospital that’s in their network, and they’ll think everything’s going to be covered.

“But what happens is, they show up, and the emergency department isn’t covered under their plan, the radiologist isn’t covered under their plan,” he said. “Let’s say they need an operation to fix a broken bone, let’s say a hip, the surgeon isn’t on their plan and neither is the anesthesiologist. This can add up to a lot of costs.”

Lauer said the problem has gotten worse across the country and in Arizona. Several years ago, a lot of people didn’t have insurance at all. Then when the Affordable Care Act passed, he said he saw it improve. More patients had health insurance and were covered in the emergency room.

However, he said that’s changing now, because insurance companies are creating narrower networks of medical providers who are covered by your plan.

“Certainly on the exchanges, the options are being limited,” he said. “Usually, your primary care physician, of course, is in that plan. But, very important specialists, such as emergency room physicians, radiologists, cardiologists, orthopedic surgeons, less and less are being covered.”

The American College of Emergency Physicians is calling for insurance companies to be more transparent with patients about what their plans cover and what they don’t. They think insurance companies should provide more coverage for emergencies.

The survey also found that 96 percent of the 2,000 emergency physicians surveyed don’t think patients understand what their policies cover when it comes to emergency care.

But, the health insurance industry is singing a different tune.

“We see this as in issue that requires and calls for responsibility from all stakeholders in the health system, hospital, physicians, and health plans,” said Clare Krusing, press secretary with America’s Health Insurance Plans, a national trade association the represents the health insurance industry.

She said they certainly recognize that someone isn’t going to look up their provider network and check what doctors are covered by their insurance plan when they’re being rushed to the emergency room.  She said hospitals and doctors need to do more, too.

“It’s important that there is a level of transparency there from the hospital, from the physician and from everyone that is treating that patient to make sure they are aware of the choices that are available to them and that the patient isn’t surprised or facing a huge bill at the end of the day, " Krusing said.

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