Eight out of 10 emergency room doctors say insured patients are skipping or delaying health care because of high out of pocket expenses, deductibles and co-insurance, according to a poll released this morning by the American College of Emergency Physicians.
The advocacy group surveyed 1,924 emergency room doctors in all 50 states, the District of Columbia and Puerto Rico. An overwhelming percentage—96%—of doctors polled also say insured patients also do not understand what their policies cover for emergency room care.
The poll also found that nine of 10 emergency room doctors believe health insurance companies are misleading patients by offering affordable premiums policies that actually cover very little.
“Each day, emergency physicians are seeing patients who have significant co-pays, up to $400 or more, for emergency care,” says Dr. Jay Kaplan, ACEP president, in a statement. “It might as well be $4,000 for some people. 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.”
Nearly two-thirds, or 62%, of the emergency room doctors polled say most health insurance companies provide less than adequate coverage for emergency care visits to their beneficiaries. Dr. Mark Rice, president of the ACEP Louisiana chapter, says the poll sums up what’s happening in Louisiana.
“Health insurance doesn’t always equal access to care,” he says.
Rice says insurance companies should make sure that patients understand what their insurance covers. Too often, he says, patients are surprised by large bills after seeking care.
What’s also notable about the survey, Rice says, is that insurance providers are continuing to narrow the selection of in-network doctors versus out-of-network doctors, shifting more costs to patients. Emergency rooms routinely fill access to care gaps.
Kaplan says this practice is creating a situation whereby patients are receiving additional bills from medical providers. When health insurance plans do not cover the cost of services, physicians must choose between billing the difference to patients or let it go unpaid, he says.
“Insurance companies must provide fair coverage for their beneficiaries and be transparent about how they calculate payments,” says Kaplan. “They need to pay reasonable charges, rather than setting arbitrary rates that don’t even cover the costs of care. 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.”
—Alexandria Burris
