The fraying safety net of emergency medicine received a reprieve recently, largely due to several ACEP members who acted on behalf of all emergency physicians to ensure that controversial model legislation did not further diminish emergency care reimbursement. In early March, the National Conference of Insurance Legislators (NCOIL) passed a model law to enhance health care transparency in relation to controversial balance billing practices.
Explore This IssueACEP News: Vol 30 – No 06 – June 2011
NCOIL’s model legislation initially prohibited balance billing, but ACEP worked with such entities as the Emergency Department Practice Management Association (EDPMA) and the American Medical Association to challenge the proposed bill. Their efforts paid off, and the model bill that NCOIL released in March ultimately focused on notification requirements for hospitals and insurers to inform patients when they may be treated for nonemergency conditions by an out-of-network physician in an in-network hospital. Emergency care was specifically exempted from all notification requirements in the model bill, which was distributed as a model to legislators in every state.
Dr. Charles Bregier Jr., immediate past chair of ACEP’s Reimbursement Committee, testified before NCOIL regarding the dire effect that a blanket prohibition against balance billing or a pretreatment disclosure mandate could have on emergency care providers and their patients.
“We didn’t think the whole issue of disclosure and transparency was appropriate in an emergency department setting,” said Dr. Bregier. “If we’re in a situation where we or a hospital representative must talk about being a nonparticipating provider when someone’s having a heart attack, patients will die.”
Dr. Michael Gerardi, a member of ACEP’s Board of Directors and liaison to ACEP’s Reimbursement Committee, testified before NCOIL that emergency care providers have been forced to balance bill because insurance companies are severely underpaying these out-of-network claims.
“Knowing that emergency providers will take care of patients no matter what (because of EMTALA), some insurers aren’t living up to their obligations,” said Dr. Gerardi. “In reality, a ban on balance billing would be a huge benefit to insurers, giving them carte blanche to arbitrarily set payments rates for emergency physicians – and all of this at a time when the ED safety net is already unraveling.”
Such legislation banning balance billing would also put patients’ lives at risk because the ban would have included emergency care consultants, such as anesthesiologists, radiologists, and cardiologists.
“If you tell a plastic surgeon or an orthopedist that they can’t balance bill, who is going to be willing to take call?” Dr. Gerardi said.