by Michelle Andrews; Kaiser Health News
Published by The Lund Report December 23, 2015
Two professional organizations representing emergency doctors warn that a new federal rule could lead to higher out-of-pocket costs for consumers when they need emergency care outside their health plan’s network of providers. But consumer advocates and health policy experts say the groups’ proposed solution doesn’t adequately protect consumers.
Under the health law, plans can’t generally charge consumers higher copayments or coinsurance when they visit an emergency department that’s not in their network. So if the plan charges a flat copayment of $500, for example, or coinsurance totaling 30 percent of the cost of services for an emergency department visit at an in-network hospital, it can’t charge consumers more than that rate if they get emergency services at an out-of-network facility. The only plans that are exempt from this provision are those that have grandfathered status under the health law.
However, the law doesn’t prohibit doctors and hospitals from “balance billing” consumers for out-of-network emergency care if their insurer doesn’t pay the full amount charged. That practice is what really harms consumers, say advocates.