The data in the New England Journal of Medicine study simply don't make sense. The authors claim it comes from a large insurance company but won't make the data available or even identify the company. Second, the study focuses on a ridiculously small percentage of emergency visits, only around 1 percent. The author's tie to a group funded by the insurance industry is also troubling.
It does not address why emergency physicians choose to take themselves out of network. Even a cursory examination would reveal they do so unwillingly, and only after insurance companies offer reimbursement rates they have no choice but to refuse. The Emergency Medical Treatment and Labor Act gives the insurance industry the upper hand in emergency situations because doctors have to see all patients, regardless of insurance or ability to pay.
State and federal policymakers need to ensure that health insurance plans provide fair payment for emergency services and that patients get their money's worth from policies they buy in good faith, which ultimately let them down in their hour of need.
Rebecca Parker, Irving, president, American College of Emergency Physicians