Costs concerns can bar people from seeking emergency careAfter being airlifted to Fort Smith, 50 miles away, her life was saved through an emergency surgery but at a cost. Since the hospital was not within her insurance network, her husband together with her ended up paying out of pocket expenses of $20, 000, a sum they wouldn’t have incurred in their network hospitals in Little Rock, 150 miles away.

What the new law says about insurance plans

The new health law requires the insurance companies to extend various new protections to the patients receiving emergency care. The biggest guarantee is that patients in need of emergency treatment are going to have their costs also covered at same rate, without considering whether they got the treatment at ‘out of network’ or ‘in network’ hospitals.

Health plans are also barred by the law from getting prior authorization for the emergency services. In addition, plans are mandated to follow the rule of the ‘prudent layperson’. For instance, if a person checks in at the Emergency Room complaining of chest pain only to be diagnosed with indigestion; such a claim must be covered simply because it made sense for the patient to visit a hospital.  These provisions will affect the health plans issued after September 23, six months after enactment of the law which offers emergency coverage.

Plans have been denying patients ER claims for many years now for a wide range of reasons. Even though only little data exists on the general scope of this study, a RAND Corp. study undertaken in 2004 showed that about a sixth of all the emergency department care claims were denied by two large California HMOs.

Reluctance in seeking care

Angela Gardner, the president of American College of Emergency said that coverage guarantees for the emergency care being included in the new health law was really a huge victory for them. Often, people can’t really stop to start checking if a certain doctor or hospital is out of or in network when an emergency situation arises.

The research suggested that the concerns about the associated costs can bar people from visiting the emergency room. According to a recent study published in the Journal for the American Medical Association, it was found that patients who were insured and have no financial concerns are highly likely to go for the emergency care within the first two hours. However, patients with some financial concerns and the uninsured ones wait for six hours and sometimes more before seeking care. Since there are some states without any regulations on this issue, enactment of the federal law is going to put in place a uniform standard. Dan Honey, deputy insurance commissioner in Arkansas said that the federal law now gives them more guts to enforce what they have all along thought was the right thing to be done.