High out-of-pocket expenses, narrow insurance networks send more patients to ERs

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Wed Nov 11 14:44:33 PST 2015


       

 

October 26, 2015

 

High out-of-pocket expenses, narrow insurance networks send more patients to
ERs 

 

 

 
<http://www.fiercehealthcare.com/story/high-out-pocket-expenses-narrow-insur
ance-networks-send-more-patients-ers/2015-10-26> Fierce Healthcare

 

 

By Julie Bird

 

Patients with health insurance are ending up in the emergency room after
delaying care because of high out-of-pocket costs including deductibles and
co-insurance, a survey by the American College of Emergency Physicians
(ACEP) found.

 

Seven out of 10 emergency room doctors reported seeing patients who delayed
seeking care because of those high costs. Two-thirds of those surveyed also
said primary care physicians are sending patients to the ER for medical
tests or procedures that insurance won't cover during office visits.

 

"Many patients are motivated by fear of costs and not by the seriousness of
their medical conditions," ACEP President Jay Kaplan, M.D., said in an
announcement, criticizing insurers for shifting more costs to patients and
providers. "They call it cost-cutting when in reality it is
profit-boosting."

 

In other findings, 60 percent said they have trouble finding specialists in
their patients' health insurance network for referrals, and more than 80
percent said their patients reported having trouble finding in-network
specialists on their own.

 

A report released earlier this year by the McKinsey Center for U.S. Health
System Reform said that 45 percent of plans offered on state health
insurance exchanges have narrow networks--and 17 percent are defined as
"ultra-narrow networks."

 

About three-quarters of those surveyed by ACEP also said they're seeing more
Medicaid patients because insurance networks didn't include enough primary
care or specialty physicians.

 

Such concerns have already drawn the attention of the National Association
of Insurance Commissioners, which is developing a new model network adequacy
law to include measures of network adequacy including provider-covered
person rations by specialty and accessibility of providers by geographic
area.

 

As a result of the challenges, 20 percent of the ACEP emergency room
physicians said either they or other ER doctors they knew were considering
opting out of health insurance networks. Nearly 90 percent cited
insufficient reimbursement rates from insurers.

 

"Balance billing would not even exist if health plans paid what is known as
'usual and customary' payment in the insurance industry--what is also known
as 'fair payment,'" Kaplan said in the announcement. "Emergency patients are
especially vulnerable because health plans know that emergency departments
never turn anyone away."

 

 

 

Jeff Wells
Deputy Editor, CAL/AAEM News Service

 

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

Contact us at:  <mailto:calaaem.news.service1 at gmail.com>
calaaem.news.service1 at gmail.com

For more articles, visit our  <http://www.calaaem.org/news_archives.php>
archives. 

 <mailto:somcaaem at uci.edu> To
<https://maillists.uci.edu/mailman/listinfo/calaaem>  unsubscribe from this
list, visit our mail server.

Copyright (C) 2015. The California Chapter of the American Academy of
Emergency Medicine (CAL/AAEM).  <http://www.calaaem.org>
http://www.calaaem.org. All rights reserved.

CAL/AAEM, a nonprofit professional organization for emergency physicians,
operates the CAL/AAEM News Service solely as an educational resource for
physicians. Dissemination of an article by CAL/AAEM News Service does not
imply endorsement, agreement, or recommendation by CAL/AAEM News Service,
CAL/AAEM, or AAEM.

Follow CAL/AAEM on Facebook and Twitter:

 

 <http://www.facebook.com/pages/CalAAEM/172577489479442?sk=wall&filter=12>
<https://twitter.com/#!/CALAAEM>
<http://escholarship.org/uc/uciem_westjem> 

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://maillists.uci.edu/pipermail/calaaem/attachments/20151111/7033d645/attachment-0001.html>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image001.jpg
Type: image/jpeg
Size: 24675 bytes
Desc: not available
URL: <http://maillists.uci.edu/pipermail/calaaem/attachments/20151111/7033d645/attachment-0004.jpg>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image002.jpg
Type: image/jpeg
Size: 877 bytes
Desc: not available
URL: <http://maillists.uci.edu/pipermail/calaaem/attachments/20151111/7033d645/attachment-0005.jpg>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image003.jpg
Type: image/jpeg
Size: 819 bytes
Desc: not available
URL: <http://maillists.uci.edu/pipermail/calaaem/attachments/20151111/7033d645/attachment-0006.jpg>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image004.jpg
Type: image/jpeg
Size: 1822 bytes
Desc: not available
URL: <http://maillists.uci.edu/pipermail/calaaem/attachments/20151111/7033d645/attachment-0007.jpg>


More information about the CALAAEM mailing list