The Prudent Layperson Standard is a part of federal law that provides an important patient protection and functions as one of emergency medicine’s bedrock principles, alongside the Emergency Medical Treatment and Labor Act (EMTALA), which ensures that anyone can receive emergency care regardless of insurance status or ability to pay.
The Prudent Layperson Standard requires insurance companies to provide coverage for emergency care based on symptoms, not the final diagnosis. This is an important distinction, because 90 percent of urgent and nonurgent symptoms overlap, and in many cases doctors don’t know if your symptoms require emergency treatment without medical examination and testing.
According to the Centers for Disease Control and Prevention (CDC), only about 3 percent of emergency visits are classified as "nonurgent."
We fought hard for many years at both the national and state levels to secure passage of legislation aimed at protecting emergency patients from retroactive denials of insurance coverage for emergency department visits for conditions that turned out not to be emergencies.
Anyone who thinks they are having a medical emergency should not hesitate to get evaluated by an emergency physician.