The prudent layperson standard is a federal law that provides an important patient protection and is one of emergency medicine’s bedrock principles alongside the Emergency Medical Treatment and Labor Act (EMTALA).
EMTALA makes sure 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 that care, based on symptoms, not the final diagnosis. An important distinction as 90 percent of urgent and nonurgent symptoms overlap. According to the according to the Centers for Disease Control and Prevention (CDC), only 4 to 5 percent of emergency visits are “nonurgent.” In many instances, doctors don’t even know if your symptoms require emergency treatment without a medical examination and tests.
Anyone with little or no medical expertise (a “prudent layperson”) could think they are having a health emergency and should not hesitate to get evaluated by an emergency physician.