ER docs: Health insurers mislead patients, sell 'affordable' policies that cover few services

Health insurers mislead patients by offering "affordable" premiums for policies that cover very little, according to a new nationwide poll of more than 1,900 emergency physicians.

The poll, conducted by the American College of Emergency Physicians, found that most ER doctors say patients don't understand what their policies cover for emergency care. "Just because you have health insurance doesn't mean you have coverage," Jay Kaplan, M.D., president of the medical specialty society, said in an announcement.

It's not unusual for patients to have copays of up to $400, an amount that is unaffordable for many people, according to Kaplan. The ACEP is calling for patients to take a close look at what their insurance policies cover and demand fair and reasonable coverage for emergency care.

"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.

Indeed, 8 in 10 ER docs said they see patients with health insurance who have delayed medical care because of high out-of-pocket costs, co-insurance or high deductibles.

Stephen Epstein, M.D., an emergency physician at Beth Israel Deaconess Medical Center in Boston, told the Boston Business Journal that he has seen patients delay necessary care and end up in the ER in worse shape.

"They are delaying things like they can't afford their medications and don't take their blood pressure medications, so they come in with a stroke," he told the publication.

The financial problems are only going to get worse because more plans now offer narrow networks of medical providers, which will make it more likely that the ER will be out of the patient's network. In that case, physicians either have to bill patients for the difference or go unpaid for their services.

"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," Kaplan said.

Other highlights from the poll:

  • 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.

To learn more:
- read the announcement
- download the report
- here's the Boston Business Journal article