Emergency Physicians Alarmed that Coverage Concerns Delay Necessary Medical Care

WASHINGTON, D.C.—A new poll from the American College of Emergency Physicians (ACEP) and Morning Consult shows that nearly half (45 percent) of adults do not realize that their health insurer must cover the cost of going to the emergency department if they reasonably believe that they are having a medical emergency. This number is alarmingly high, especially when you factor in another recent poll which found that when considering going to the emergency department, nearly seven out of ten people are concerned that their insurance provider will refuse to cover them.

“In a medical emergency, seconds count,” said Gillian Schmitz, MD, FACEP, president of the American College of Emergency Physicians (ACEP). “If you really think you’re having an emergency, you shouldn’t hesitate to seek medical care from your local emergency department.”

This patient protection, known as the Prudent Layperson Standard, requires insurers to cover emergency care based on a patient’s symptoms, not their final diagnosis. This is a critical distinction as about 90 percent of symptoms overlap between urgent and nonurgent conditions, leaving it nearly impossible for a person with no medical training to determine whether their symptoms are minor or life-threatening before they go to the emergency department.

“Increasing everyone’s familiarity of the protections in place to make sure they can promptly seek emergency care anytime they need it will ultimately save lives,” said Dr. Schmitz. “No one should die of doubt when there are emergency physicians willing and able to save them.”

Together with the Emergency Medical Treatment and Labor Act, these policies form the bedrock of our nation’s health care system safety net and ensure that anyone can seek medical care without delay or concern about their insurance coverage. However, emergency physicians are deeply concerned that when insurance companies violate the Prudent Layperson Standard and refuse to cover emergency care it causes people to second-guess whether to go to the emergency department when they need medical attention.

Insurers continue to find new ways to skirt their obligation to patients and violate federal law. Just this past summer, ACEP led the pushback that forced one of the largest insurance companies to abandon its threat to retroactively denying coverage for emergency care.

“If history is any indication, insurance companies will do everything they can to avoid covering emergency services unless they are stopped,” said Dr. Schmitz. “ACEP and its members will continue the fight to hold insurers accountable for their obligations and protect the safety of the millions of people who rely on timely access to emergency care.”