Planning
a trip should include learning about your health coverage because
you may find that seeking emergency medical service away from
home can be complicated and costly. Already the law requires that
emergency care be given to anyone who needs it. But for the insured,
doctors believe many managed care plans have created administrative
and financial barriers that can delay or prevent patients from
getting the care they need in an emergency.
That's
why the American College of Emergency Physicians (ACEP) is urging
Congress to require health insurance plans that offer emergency
care to pay for those services. Here are some important questions
to ask your provider before you leave home: How do they define
a health emergency? Do you need permission from your insurance
provider to make an emergency department visit?
Can
you go to any emergency department? Is your provider available
24 hours a day to approve your emergency visit? Will your plan
pay for emergency department screening exams? Once admitted, will
the physician on duty need authorization from your provider before
treating you? One particularly pressing problem patients confront
after their emergency visit is insurance companies that refuse
to pay for conditions that turn out not to have been emergencies.
Dr.
Larry Bedard, president of ACEP, said, "For example, say you have
severe chest pain. Are you having a heart attack? If you sensibly
go to an emergency department to find out, before checking with
your health care insurance provider, as some plans require, you
may be faced with a big bill after tests determine that you really
had indigestion." Some insurance companies refuse to pay for emergency
services they have not authorized.
The
American College of Emergency Physicians is concerned that this
approach can lead to more serious conditions or death for those
who in a real health emergency would not seek help because it
might cost them money. The College has been instrumental in introducing
legislation that will promote coordination between health insurers
and doctors; giving patients the consideration they deserve.
Referred
to as H.R.815, S.356, or "Access to Emergency Medical Services
Act of 1997," it mandates insurance coverage for conditions tat
a knowledgeable layperson could reasonably expect would result
in serious impairment without emergency help. SOURCE:From the
American College of Emergency Physicians
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