Health Plans Not Required To Pay Fairly for Emergency Care, Under New Regulation

Dec 01, 2015, 09:04 ET from American College of Emergency Physicians (ACEP)

WASHINGTON, Dec. 1, 2015 /PRNewswire-USNewswire/ -- The federal government last week issued a new regulation that allows health insurance companies to pay doctors in emergency departments essentially whatever they like, opening the door to the possibility of reimbursements that do not even cover the costs of care. The American College of Emergency Physicians (ACEP) expressed astonishment at the ruling, given the feedback emergency physicians have given to CMS over several years, as well as the timing. Dr. Jay Kaplan, president of ACEP, said that the organization was considering legal action.

"This new ruling will significantly benefit health insurance companies at the expense of physicians, because they know hospital emergency departments have a federal mandate to care for everyone, regardless of ability to pay," said Dr. Jay Kaplan. "They will continue to shift costs onto patients and medical providers, as well as shrink the number of doctors available in plans. Instead of requiring health plans to pay fairly, this ruling guarantees that insurance companies can pay whatever they want for emergency care. If history tells us anything it's that insurance companies prefer to pay as close to nothing as possible, while building their war chest for profits and litigation."

According to the ruling, even the minimum standards of payment are "not necessary" in states that have banned balance billing. Balance billing occurs when health plans pay unreasonably low reimbursements, and physicians are forced to bill patients for the unpaid "balances" (similar to how a dentist bills). Health insurance companies have taken gross advantage of patients and emergency medical providers since the ACA, arbitrarily slashing payments to physicians by as much as 70 percent.[i]

"This is a scary environment for patients," said Dr. Kaplan. "Insurance companies are alleging that doctors are charging too much, rather than admitting they are paying too little. This ruling by CMS unfortunately suggests that the federal government is on the side of Big Insurance rather than patients and their physicians."

In a recent poll, seven in 10 emergency physicians responding to a poll reported seeing patients with health insurance who delayed medical care because of high out-of-pocket expenses, high deductibles or high co-insurance.

The new regulation was issued by the Department of the Treasury, the Department of Labor and the Department of Health and Human Services.

About ACEP:

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. 

[i] Wall Street Journal. "Surprise Bills for Many Under Health Law." June 11, 2015

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SOURCE American College of Emergency Physicians (ACEP)