High-deductible, limited-network plans squeeze ERs, beset patients
I was disheartened to read Liz Kowalczyk’s article on patients receiving unexpected bills for out-of- network health care services. As an emergency physician practicing in Boston for nearly 20 years, I agree that this is unacceptable. Patients should never get stuck with unexpected bills, especially for emergency care. But the reality is that insurers who offer high-deductible and limited-network plans increase the likelihood that patients will get stuck with a huge bill.
The issue of out-of-network billing is of paramount importance to the Massachusetts College of Emergency Physicians. That’s because, by federal law, emergency physicians cannot say no to any patient who presents to the ER with an emergency, regardless of insurance status. That puts us in a different place than other specialties in negotiations with health insurers.
The suggestion by insurers that physicians prefer to remain out of network because reimbursement is higher than that of negotiated rates is misleading and insulting to emergency physicians. More accurate is that some insurers are offering inadequate rates, while others deliberately refuse to contract so as to preserve their limited-network plans, knowing full well that we must care for the patient, whether the insurer reimburses us adequately or not.
The Massachusetts College of Emergency Physicians supports taking the patient out of the middle. We ask for increased transparency of the limitations of insurance coverage, a dispute resolution process for providers, and fair reimbursement for services based on a national and robust independent database. We appreciate being at the table with our other physician colleagues, the Legislature, and the Baker administration, and hope that this issue is resolved soon and fairly — for our patients’ sake.
Dr. Scott Weiner
Massachusetts College of Emergency Physicians