American College of Emergency Physicians | News Room - Published Letters

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Keep reasonable insurance coverage for emergency care 

As Congress debates repeal and replacement of health care reform, there are provisions in the Affordable Care Act that are essential to millions of emergency patients and must be protected. More than 9 in 10 registered voters in a recent poll said that health insurance companies should include coverage for emergency medical care. While this may not seem like a big deal, you want to make sure that you have access to an emergency department when you believe that you are having an emergency.

When asked if someone visited an emergency department because they believed they were having a heart attack, but were later diagnosed with a panic attack, more than 8 in 10 (83 percent) said that health insurance plans should cover the visit.

The principle of covering medical care based on symptoms that most people would consider potentially life-threatening, rather than the final diagnosis, is called the “prudent layperson" standard. This was codified into federal law, including the Affordable Care Act, following years of denials of coverage for emergency care by health insurance companies. For many of our patients, going to the emergency department is their only option to seek health care when they need it.

We can’t choose where and when we will need emergency care and shouldn’t be punished for having emergencies. We urge all of our patients to investigate what their health insurance policy covers and make sure that policymakers and insurance companies provide fair and reasonable coverage for emergency care.

Dr. Evan S. Schwarz  •  Brentwood
Vice president, Missouri College of Emergency Physicians