American College of Emergency Physicians | News Room - Published Letters

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Editor: As president of the Pennsylvania College of Emergency Physicians, I commend The Times-Tribune for reporting on the issue of out-of-network emergency care.

Our organization agrees that no Pennsylvanian should have to worry about insurance networks in an emergency. During an emergency, everyone should go to the closest, most appropriate, emergency department and expect that their insurance company will fulfill its promise to pay the bill. As emergency physicians, we provide 24/7/365 care to all people who come to us. It is our moral obligation to provide care and it is our legal requirement under federal law to do so without consideration of ability to pay or insurance status.

The real issue is that insurers create a gap when they sell policies that “cover” emergency care, but do not follow through on their reimbursement obligations. Insurance companies take advantage of the fact that emergency physicians will care for any patient by narrowing physician networks and paying unreasonably low reimbursement rates. This leaves patients with high out-of-pocket costs. We agree that the Legislature should take patients out of this issue while ensuring that reimbursement to physicians is fair. Such reimbursement should be based on the usual and customary rate for such services in the community where they are being provided, based on an independent database, and not be determined exclusively by an insurance company. A national database already exists due to a settlement against an insurance company for unfair practices.

Emergency physicians and emergency departments are the health care safety net for Pennsylvania and the nation. To make sure we all have access to excellent emergency services, the issue of out-of-network billing should be resolved legislatively in a manner that protects patients and ensures that insurance companies provide fair emergency care reimbursement.