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Emergency Coverage Top Healthcare Consumer Demand For Payers

When talking about access to care, healthcare consumers were highly in favor of transparency and want payers to cover emergency services.

Emergency Services a High Demand for Healthcare Consumers

Source: Thinkstock

By Thomas Beaton

- A new poll from the American College Of Emergency Physicians (ACEP) and Morning Consult found that 95 percent of healthcare consumers say payers should cover emergency services.

Out of the 1,791 healthcare consumers surveyed, about 31 percent had visited an emergency department with 35 percent saying they went to the emergency department because they were unable to get a physician appointment.

"Provisions currently in the ACA [Affordable Care Act] that directly benefit emergency patients must be protected," said Rebecca Parker, MD, FACEP. "Patients can't choose where and when they will need emergency care and they shouldn't be punished financially for having emergencies."

"Emergency physicians are advocating for transparency and use of independent databases, such as Fair Health" said Dr. Parker.

Healthcare consumers in the survey view emergency care as essential because it provides critical, life-saving healthcare services to millions of individuals. However, the ACEP reported that emergency physicians represent only 4 percent of doctors even though they provide 28 percent of acute care visits, 50 of Medicaid and CHIP visits, and 67 of acute care to uninsured patients.

Emergency care is an important area for payer improvement as more consumers need and want access to emergency services. Other poll results show that 80 percent of respondents found it was very important that payers cover emergency care.

ACEP stated that patients are inheriting too much of the emergency care costs and that policymakers should allow better access to a higher volume of emergency physicians.

The survey also explored healthcare consumer views on their future healthcare costs and benefits. About 62 percent of respondents said they think their costs will increase and 36 percent said their benefits will worsen.

Another 37 percent believe costs will stay the same.

"The growth of out-of-pocket costs and the reductions of in-network physicians and hospitals are leaving insured people barely covered in an emergency,” ACEP said.

“State and federal policymakers need to ensure that health insurance plans provide adequate rosters of physicians, affordable deductibles and co-pays and fair payment for emergency services. We encourage all patients to investigate what their health insurance policy covers and demand fair and reasonable coverage for emergency care."

The respondents also expressed interest in payer transparency as well as information access on how payments are calculated and billed.

When asked to rate how important it was for insurance companies to let patients know how they calculate payments for emergency care, 67 percent rated it as very important while 4 percent rated it as either not that important or not important at all.

Another problem the ACEP found with the emergency care environment is when patients have to “self-diagnose” their conditions, such as confusing a panic or anxiety attack with a heart attack. In these situations, the patient usually pays out-of-pocket costs for the visits.

When respondents were hypothetically asked the same scenario, 83 percent said that the insurance company should cover the cost of an emergency room visit if a panic attack was confused for a heart attack.

"Emergency physicians fought long and hard for the 'prudent layperson' standard on behalf of our patients," said Dr. Parker. "Patients should not be forced to diagnose their own medical conditions. It's dangerous. Most people lack the training to determine what constitutes a medical emergency.”

“In fact, physicians can't tell if it's an emergency condition until completing a medical screening exam,” he continued. “Patients should not be put in the position of self-diagnosing at home. Their lives depend on it."

Respondents also said that they want to better understand how their insurance costs are calculated. Approximately 36 percent of the respondents said they think medical payments should be determined through a transparent, independent cost base and formula.

Other responses included using a cost standard developed by the government (15 percent), costs and databases developed by an insurance company (13 percent), and a cost standard developed by the entire insurance industry (9 percent).

The remaining 28 percent cited other payment structures or didn’t have an opinion.

The poll results found that most of healthcare consumers do not feel they are getting the transparent, fair price for services. As a result, they voiced their distrust with the medical billing experience.

When the organizations asked consumers about hypothetically receiving care at an in-network hospital but they received bills from an out-of-network physician, 46 percent said they would feel mislead by their insurance company, hospital, and physician.

Only 8 percent of respondents never felt mislead by a payer, hospital, or physician. 

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