In January 2026, large health insurance company leaders were summoned to Washington, D.C., for congressional hearings about their role in skyrocketing health costs.

Seizing the moment, ACEP shared a statement detailing a pattern of bad insurer behavior and the policy fixes needed to make them stop. ACEP cited denials of medically necessary care, misuse of prior authorization requirements, and continued attempts to weaken the prudent layperson standard.

“Insurers continue to exploit our health care system and the individuals and families they ostensibly cover, all for the sake of increasing record profits,” ACEP wrote.

Insurers routinely fail to conduct business in good faith, and ACEP is working on legislation to stop tactics that drive up costs and threaten patient access to emergency care.

Insurers Compound the Strain on Emergency Physicians

Emergency physicians work under federal EMTALA law requiring them to evaluate and stabilize any patient who seeks care, regardless of insurance status or ability to pay. As a result, emergency medicine involves more uncompensated care than any other medical specialty. According to an April 2025 RAND report, across all payers, 20 percent of emergency physician payments go entirely unpaid, a $5.9 billion annual shortfall that exacerbates resource constraints and hinders access to emergency care.

Insurers compound the existing strain on emergency physicians by doing all they can to delay, deny and avoid their payment obligations. “The persistent failure of insurance companies to conduct business in good faith will keep driving up costs and impeding access to care, unless they are stopped,” said ACEP President L. Anthony Cirillo, MD, FACEP.

ACEP Puts the Pressure On

The message to Congress builds on ACEP advocacy to confront insurer misconduct at federal and state levels.

Most recently, ACEP pushed back against Anthem’s new policy that will penalize facilities when care is delivered by an out-of-network clinician. ACEP warned that Anthem’s approach would undermine continuity of care, conflict with federal protections under the No Surprises Act, and further strain emergency departments.

ACEP can apply the right kinds of pressure to compel insurance companies to roll back abusive policies, including payment denials, downcoding, reimbursement delays, and other tactics, putting emergency physician practices at risk.

ACEP’s latest appeal to Congress reflects the clear reality that existing laws are only as effective as their enforcement.

Accountability is the Missing Ingredient

Insurers must be held accountable for their actions, and lawmakers and regulators have an opportunity to strengthen oversight, improve transparency around insurer practices, and impose real consequences when insurers fail to act in good faith.

“ACEP strongly supports robust enforcement of laws and regulations meant to halt patterns of insurer misconduct that have only become more egregious in recent years,” said Dr. Cirillo.

Putting Physicians and Patients First

Emergency physicians should be focused on saving lives, not fighting insurers for payments.

As Congress weighs next steps, ACEP reaffirmed its commitment to work with lawmakers to advance policies that enforce existing protections and ensure that emergency care remains accessible to every patient, in every community, at every hour.

ACEP is urging Congress to pass the No Surprises Act Enforcement Act (H.R. 4710/S. 2420), and members can use the new ACEP action alert to contact their legislators and ask them to cosponsor this important bipartisan legislation that will help hold insurers accountable for continued gaming of the No Surprises Act.

Emergency medicine is always there when patients need it. ACEP will continue calling on Congress to ensure that insurance companies meet that same standard.