State Medical Association Takes Legal Action to Enforce Law; Protect Patients

Jennifer Lawrence Hanscom
Senior Director/Chief Operating Officer
(206) 484-7647 or [email protected]

December 9, 2010, SEATTLE - Today the Washington State Medical Association (WSMA) filed a Writ of Mandamus with the State Supreme Court seeking to have the Washington state Insurance Commissioner enforce current state law.

The Writ seeks to require that Commissioner Mike Kreidler enforce the statute (RCW 48.43.093) that requires health insurers pay for the emergency services of their policyholders, even when the physician providing those services is not contracted with the insurer. The law was passed in 1997 and was enforced by Kreidler's predecessor, Deborah Senn. Also signing on to the Writ is the Washington Chapter, American College of Emergency Physicians (WA-ACEP). WA-ACEP represents over 620 emergency physicians throughout Washington state.

"The Office of the Insurance Commissioner is failing to enforce current law that specifically protects insured patients from having to pay costs that are the health insurers' responsibility," said Dr. Dean Martz, president of the WSMA.

The law was enacted to ensure that patients get the care they need in an emergency without delay or unnecessary expense. The law was passed as part of a comprehensive health insurance reform bill. The bill established for the first time in state statute the coverage requirements and conditions for emergency services provided in a hospital emergency department. It requires health insurers to cover the cost of emergency services necessary to screen and stabilize the patient.

"During an emergency, the last thing a patient should have to do is call their health insurer to find out if the physicians treating them are part of their insurer's network. When a patient shows up in the emergency department needing care, time is of the essence," said Dr. Martz. "Expecting patients or their families to go through such a process is ridiculous. That is why this law was enacted: to make sure that patients get the care they need in an emergency without delay or unnecessary expense."

Added WA-ACEP president, Dr. John Milne, "Nearly 65% of patients arrive in the ED between 5:00 pm-8:00 am Monday through Friday, and on the weekends-when most 1.800 operators are not available. Patients in emergency situations do not have time to wait for WSMA Takes Legal Action December 9, 2010 Page 2

approval and in many situations don't have the luxury of waiting for a contracted physician to arrive. They need care and they need it immediately."

Health insurers had previously agreed to comply with the law. In fact in 2000, then Commissioner Senn conducted a statewide campaign imploring Washington state residents to call 9-1-1 and not their insurers' customer service numbers during an emergency. The message, "Washington state law requires insurers to cover the cost of screening and stabilizing emergency room patients when a prudent layperson would have sought emergency treatment under the same circumstances."

Said Dr. Martz, "It is unclear why the OIC has stopped enforcing the law, a law that is plainly written and an effective way of protecting patients from unexpected emergency care costs. Our action today seeks to have current Washington law enforced."

The Writ of Mandamus seeks to have the Insurance Commissioner enforce RCW 48.43.093 as written and as intended by the legislature-to require health insurers to pay the billed charges of nonparticipating providers for emergency services, less the specific cost-sharing arrangements permitted under the statute.