96% of patients don't understand their emergency insurance coverage: 6 findings from the ACEP

Emergency physicians are treating an increasing number of patients who don't understand their insurance coverage or the financial repercussions for receiving emergency care outside their network.

That finding comes from a new national poll of emergency physicians conducted by the American College of Emergency Physicians. The survey aimed to understand the impact the Affordable Care Act has had on insured patients' ability to pay out-of-pocket medical costs.

The online poll surveyed 1,924 emergency physicians between April 4 and April 11.

Below are six findings.

1. Nine in 10 respondents said they believe health insurance companies are misleading patients by offering affordable premiums for policies that actually have very little health coverage.

2. Nearly 96 percent of respondents said emergency patients do not understand what their policies cover in regard to emergency care.

3. About 80 percent of respondents said they are seeing patients with health insurance who have sacrificed or delayed medical care due to unaffordable out-of-pocket costs, co-insurance or high deductibles. ACEP said this is a 10 percent increase compared to six months ago, when emergency physicians were asked the same question.

4. Nearly two-thirds (67 percent) said they believe most health insurance companies provide less-than-adequate coverage for emergency care visits to their members.

5. Of respondents who were familiar with the FAIR Heath database, 79 percent said they believed it was the best mechanism available to ensure insurance companies do not short-change or miscalculate reimbursement payments.

6. About 87 percent said insurance companies should pay the in-network rate for emergency care provided by out-of-network physicians if the patient didn't have the option of going to an in-network facility or physician.


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