WASHINGTON, D.C.—Nine in 10 emergency physicians responding to a new poll said that health insurance companies are misleading patients by offering “affordable” premiums for policies that actually cover very little. Nearly all (96 percent) said that emergency patients do not understand what their policies cover for emergency care.

“Each day, emergency physicians are seeing patients who have paid significant co-pays, up to $400 or more, for emergency care,” said Jay Kaplan, MD, FACEP, President of ACEP. “For many people, this is too much of a financial burden and will deter them from seeking emergency care. Patients should not be punished financially for having emergencies or discouraged from seeking medical attention when they are sick or injured. No plan is affordable if it abandons you when you need it most.”

According to the poll, which was conducted in the United States by Marketing General Incorporated on behalf of ACEP, eight in 10 emergency physicians are seeing patients with health insurance who have sacrificed or delayed medical care because of high out-of-pocket costs, co-insurance, or high deductibles. This is more than a 10 percent increase over six months ago when emergency physicians were asked the same question.

In addition, Dr. Kaplan said that health insurance companies are creating narrow networks of medical providers to save money, making it more likely that patients will be out of network. They have created a situation where patients are receiving additional bills from medical providers.

“Insurance companies must be transparent about how they calculate payments and provide fair coverage for their beneficiaries and pay reasonable charges rather than setting arbitrary rates that don’t even cover the costs of care. They are exploiting federal law [EMTALA] to reduce coverage for emergency care, knowing emergency departments have a federal mandate to care for all patients regardless of their ability to pay.” —Jay Kaplan, MD, FACEP

“Insurance companies must be transparent about how they calculate payments and provide fair coverage for their beneficiaries and pay reasonable charges rather than setting arbitrary rates that don’t even cover the costs of care,” said Dr. Kaplan. “They are exploiting federal law [EMTALA] to reduce coverage for emergency care, knowing emergency departments have a federal mandate to care for all patients regardless of their ability to pay. Because of this, when plan reimbursements do not cover the cost of providing services, physicians must choose between billing patients for the difference or going unpaid for their services. The vast majority of emergency physicians and their groups prefer to be ‘in network.’”