Dr. Taylor: I’ve looked at that specifically. So emergency care is included in the deductibles, and it’s actually worse because some of the plans require a facility fee of up to $500. So even if you have a low deductible and reasonable coinsurance, you’re going to have that minimum of a facility fee, and that also applies to some plans with regard to hospitalization admission on a per-day basis. You may have to pay up to $2,000 per day.

Dr. Klauer: What you two have said leads me to what I think is an obvious question: If we have people in the insurance pool right now who maybe don’t have great plans but they have coverage and now they’re going to switch over to this type of system, are we at risk of converting people who were going to be covered patients in the emergency department to patients who are now effectively uninsured self-pays in the emergency department? Is this negatively impacting our situation in the emergency department based on these plans?

Dr. Taylor: We probably don’t functionally impact those who are currently uninsured. However, once the employer mandate starts, you’re going to see shifts in those plans where I believe we will be creating an underinsurance situation, or what I like to call functionally uninsured, throughout the current insured population. So the scenario that Tony mentioned I believe will expand to a large segment of the population, and the ultimate result is that the immediate dollars available for emergency care will decrease and we’ll be chasing individuals for their deductibles like we have never seen before.

Dr. Klauer: We have people who, perhaps, have decent plans now who’ve got to choose one of these new plans. If they elect not to do it or they end up having a high deductible and they come to the emergency department—where, a year ago, their plan would have paid us something—now it’s all their burden, and we may not be able to get anything from them. Until they meet their deductible and premium, they’re effectively a self-pay to us.

Dr. Taylor: Well, you’ll be able to get something from them, but you’re going to have to chase it; it’s much more difficult. The days of submitting a bill to their insurance plan and getting a check in 30 days I believe will be largely gone, and you’ll be chasing this money for months.