Insurance companies focus on bottom line, and it isn’t patients

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Insurance companies focus on bottom line, and it isn’t patients

Have you checked the fine print of your health insurance coverage recently?

In a recent poll by the American College of Emergency Physicians, 96 percent of emergency physicians involved said patients don’t understand what their policies cover. Every day in Nevada emergency rooms, we see patients who are shocked by large co-pays for emergency care.

Further, we routinely see patients who have insurance but must come to the ER because they cannot find a primary-care provider, let alone a specialist, who accepts their insurance. A few weeks ago, I saw a young man who needed to get a vaccination for rabies (the consequence of a misadventure while he was on an international holiday). Although he was insured, he didn’t have a doctor. He went to an urgent-care business, which referred him to the Health Department, which referred him to me. We were both stunned that his insurance co-pay was $300. Not many people can afford that for a vaccine.

In a nutshell, insurance does not equal access to care.

And at least my vaccination patient had insurance. Despite the Affordable Care Act, many Nevadans lack coverage. Their only option is the ER. We are the safety net of American health care. The ER is where anyone can go, at any time, for any reason.

The nurses and doctors in Nevada identified these concerns years ago. In fact, I wrote about it in this newspaper in May 2013, where there was planned legislation that could have destroyed the safety net.

Luckily, that disaster of a plan fell apart without a vote.

The insurance companies also know patients rely on the safety net and use this to help their profits. Medicine has reached out with multiple plans to protect patients. We have suggested an arbitration model that has worked elsewhere. We have suggested using a database that contains published usual charges.

Unfortunately, we are met with apathy from the insurance companies. Who can blame them? They have to keep their shareholders happy.

Patients pay premiums every month with the expectation that their insurance will actually help them in an emergency. It is time that health insurance companies pay their fair share and stop jeopardizing patients to increase the corporate bottom line.

Greg Juhl, MD, is a past president of the Nevada Chapter of the American College of Emergency Physicians.