WASHINGTON, May 19, 2016 /PRNewswire-USNewswire/ -- Following a federal government decision in favor of health insurance companies, the nation's emergency physicians filed suit against the U.S. Department of Health and Human Services (HHS) to require transparency of data and fair insurance coverage for emergency patients who are "out of network" because of a medical emergency.
According to the lawsuit, insurance companies have failed to provide fair coverage for their insured patients. They have forced health care providers out of their health plans by offering reimbursement that barely covers the cost of care and constructed narrow networks that offer little coverage for emergency care in many parts of the country.
"Patients can't choose where and when they will need emergency care and should not be punished financially for having emergencies," said Dr. Jay Kaplan, president of the American College of Emergency Physicians (ACEP). "Health insurance companies need to be transparent about the data they are using to pay for services provided by out-of-network providers. They have a history of data manipulation and not paying for emergency care. They are shifting their responsibility to our patients, and that is just wrong. The federal government has done an injustice to emergency patients and emergency physicians by giving carte blanche to insurance companies to pay whatever they want. Historically we know that amounts to as little as possible."
HHS has acknowledged that the Affordable Care Act requires that a reasonable amount be paid based on an objective standard when patients receive emergency care from providers who are not in the plan's network. But the regulation adopted does not hold insurance companies accountable to do what the ACA requires.
Dr. Kaplan said ACEP worked with CMS for 4 years to address the out-of-network issue, which is why physicians were shocked by the final rule that allows insurance companies to arbitrarily set their own rates and shift costs they should be paying to patients. The new rule further states that even 'minimum standards of payment are not necessary' in states that have banned balance billing. This decision essentially allows insurance companies to set whatever prices they want without regard to the consequences to patients, health care providers, and our nation's safety net of emergency care.
"Health insurance companies have taken gross advantage of patients and emergency medical providers since the ACA, arbitrarily slashing payments by as much as 70 percent," said Dr. Kaplan. "They are forcing many providers out of their networks by imposing ridiculously low rates of reimbursement. In addition, health insurance companies are misleading patients by offering so-called 'affordable' premiums for these policies that cover very little because of the narrow networks, high co-pays and astronomical deductibles. It is insurance in name only because there is hardly any real coverage for the patient."
ACEP is asking the federal court to clarify the usual and customary standard, and ultimately to overturn this rule because it was adopted in violation of the government's rulemaking procedures and does not meet the standards required by the Affordable Care Act.
"We are fighting for our patients to get the coverage they deserve and for the thousands of dedicated men and women who staff our nation's emergency care safety net at all hours every day," said Dr. Kaplan.
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.
SOURCE American College of Emergency Physicians (ACEP)