ER doctors say emergency care should be a basic insurance benefit

As President Donald Trump and the GOP-led Congress look to repeal and replace the Affordable Care Act, a new poll finds that 95% of Americans want health insurance companies to cover emergency medical care.

Indeed, Morning Consult’s poll (PDF) of 1,791 registered voters conducted on behalf of the American College of Emergency Physicians (ACEP) indicates that the public believes emergency care should be a basic benefit of all health insurance plans.

“It’s clear that people want emergency care covered by insurance companies as an essential benefit. Ninety-five percent said so. But initiatives at the state and federal levels for insurance coverage do not cover emergency care. This is a grave mistake," said Rebecca Parker, M.D., president of ACEP, during a press conference Thursday to announce the findings.

The poll also found that:

  • Eighty-three percent of those surveyed believe health insurers should cover emergency visits when patients seek care in the emergency department for a suspected heart attack but later are diagnosed with a panic attack.
  • Nine in 10 Americans say that health insurers should let patients know how they calculate coverage for emergency care. A third of those registered voters want insurers to determine payments based on a transparent, independent cost database and formula.
  • Nearly two-thirds (65%) oppose the requirement that patients must get pre-authorization from their insurance companies before seeking care in the ER.

Parker said emergency physicians want to be part of the discussions with lawmakers and policymakers to ensure that emergency care isn’t overlooked in the repeal and replace plan. Historically, she said, insurers have routinely denied claims based on a patient’s final diagnosis instead of symptoms, leaving patients stuck with medical bills that the insurance company should have covered.

Those financial concerns often cause patients to delay treatment. For example, Parker said that one patient she treated last year waited too long to seek care in the ER for chest pain. By the time the patient arrived, it was too late. “The tragedy could have been avoided but my patent’s fear of costs overrode everything,” Parker said.

She also pointed to the case of Jacqueline Lee, who fell 40 feet while hiking and was unconscious when she was airlifted to the emergency room. Her insurance company denied coverage for the visit because she didn’t get preauthorization. That case, Parker said, was prior to the “prudent layperson standard,” which became federal law and was included in the Affordable Care Act. Parker worries that lawmakers have forgotten why that law was established.

“Patients support this and so do physicians,” Parker told reporters. “Patients can’t choose when and where they need emergency care and they should not be punished financially when they have to go to the emergency room.”

Furthermore, she said, patients shouldn’t be sitting by a computer, clutching their chest, trying to find out if they should call 911 or see if their insurance company will pay for the visit.

The problem is also compounded by the fact that many insurers offer high-deductible plans with narrow networks which actually decrease access to care, according to Jon Mark Hirshon, M.D., Ph.D., a member of ACEP’s board of directors and a professor of emergency medicine a the University of Maryland School of Medicine.

“Many people don’t realize how much they pay out of pocket and how little insurance coverage they have until they need medical care and then they are shocked by how little health insurance pays."

Hirshon said that insurance companies blame physicians for the charges, calling them “surprise bills,” when in reality it’s a “surprise insurance gap.”

For more on the ACEP's position and the poll, watch the video below: