According to the poll of 1,924 emergency physicians conducted in April 2016:

• Nearly two-thirds (61 percent) said most health insurance companies provide less-than-adequate coverage for emergency care visits to their beneficiaries.
• More than 60 percent of emergency physicians have had difficulty in the past year finding in-network specialists to care for patients, with a quarter of them saying it happens daily.
• 91 percent of emergency physicians said a new rule by the Centers for Medicare & Medicaid Services (CMS) exempting health insurance companies from meeting minimum standards—to ensure adequate networks—would make finding specialists and follow-up care for patients more difficult.
• Of the 934 emergency physicians who were knowledgeable about reimbursement issues, more than 78 percent said that insurance companies have reduced the amount they reimburse for emergency care.
• 79 percent of the emergency physicians who were familiar with the FAIR Health database said it is the best mechanism available to ensure transparency and to make sure insurance companies don’t miscalculate payments.

Dr. Kaplan said health insurance companies have a long history of not paying for emergency care and of actively discouraging their customers from seeking it. For example, UnitedHealthcare was sued successfully by New York state for fraudulently calculating and significantly underpaying doctors for out-of-network medical services. They used the Ingenix database, which forced patients to overpay up to 30 percent for out-of-network physicians. The company—which at the time was led by the current acting head of CMS, Andy Slavitt—paid the largest settlement to New York state and the American Medical Association. Part of that settlement created the FAIR Health database.

“Just because you have health insurance doesn’t mean you have access to medical care,” said Dr. Kaplan. “State and federal policy makers need to ensure that health insurance plans provide adequate rosters of physicians and fair payment for emergency services. We encourage all patients to investigate what their health insurance policy covers and demand fair and reasonable coverage for emergency care.”