ACEP Presents Framework To Protect Emergency Patients From Out-Of-Network Billing Issues

Washington, DC—As legislators on Capitol Hill prepare to address the surprise billing issues that are affecting millions of patients across the country, the American College of Emergency Physicians (ACEP) today released a framework of proposed solutions to protect emergency patients.  

“By oath and by law, emergency physicians will treat any patient, regardless of their ability to pay,” said Vidor Friedman, MD, FACEP, president of ACEP. “In fact, that federal law, the Emergency Medicine Treatment and Labor Act (EMTALA) actually forbids emergency care providers from discussing with the patient any potential costs of care or details of their particular insurance coverage until they are screened and stabilized. Patients can’t choose where and when they will need emergency care and they should not be punished financially for having emergencies.”

Dr. Friedman adds that with this framework of proposed solutions, we are ensuring that patients are truly taken out of the middle of billing issues that can frequently arise around insurance coverage of emergency care.

ACEP’s proposed solutions include:

  1. Prohibit balance billing—When a patient receives out-of-network emergency care, the provider will make no demand for payment from the patient.

  2. Streamline the process to ensure patients only have a single point of contact for emergency medical billing and payment—Under ACEP’s proposal, insurers will directly pay any coinsurance, copay, and deductible for emergency care to the provider, and can then collect back these amounts from the patient. This will put an end to patients receiving and having to reconcile the multiple, confusing bills and explanation of benefits that result from the many providers who often need to be involved in a single emergency episode.

  3. Ensure the patient responsibility portion for out-of-network emergency care is no higher than it would be in-network—When facing an emergency, patients or their family members don’t have time to try and figure out where their care will be in-network, so they shouldn’t be punished financially for being unable to do so. Under current law, while copays and coinsurance must be the same for emergency patients whether they are in- or out-of-network, deductibles can be much higher—often double! We think that needs to change.

  4. Require insurers to more clearly convey beneficiary plan details— This would include printing the deductible on each insurance card. While a simple step, it can help patients understand the limits of their insurance coverage and reduce the surprise when they later get a bill.

  5. Require insurers to more clearly explain their rights related to emergency care—Policyholders deserve to have this in plain, easy-to-understand clear language.

  6. Take the Patient Out of Insurer-Provider Billing Disputes—ACEP wants to prevent provider/insurer billing disputes. To expedite and simplify this process, ACEP is calling for the creation of an arbitration process to settle network issues.

The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million Americans they treat on an annual basis. For more information, visit www.acep.org.

Contact: Maggie McGillick | mmcgillick@acep.org | Twitter @EmergencyDocs

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