After 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\u2019t have incurred in their network hospitals in Little Rock, 150 miles away.<\/p>\n
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 \u2018out of network\u2019 or \u2018in network\u2019 hospitals.<\/p>\n
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 \u2018prudent layperson\u2019. 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.\u00a0 These provisions will affect the health plans issued after September 23, six months after enactment of the law which offers emergency coverage.<\/p>\n
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.<\/p>\n
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\u2019t really stop to start checking if a certain doctor or hospital is out of or in network when an emergency situation arises.<\/p>\n