ER docs: Insurers should cover emergency care

Emergency physician Dr. Tiffany Medlin Osborn thinks patients should be able to go to the closest facility for emergency care, regardless of the patient's health plan

By Rea Blakey
CNN Medical Unit

WASHINGTON -- Dr. Tiffany Medlin Osborn fights for patient rights every day. As an emergency physician at the University of Maryland Shock Trauma Center she's frustrated with the way some health insurers treat patients.

"One, the phone does not equal a physical. Two, care should not equal fear. And three, you should be able to go to the closest facility to get your care," she said.

Many ER physicians say that too often, insurance companies create barriers to emergency care.

"Pre-authorization doesn't make any sense in an emergency situation," said Dr. Michael Rapp of the American Association of Emergency Physicians.

The emergency care section of the Senate's patients' rights bill guarantees access to emergency rooms without the need for prior authorization, regardless of whether the ER participates in the patient's health plan.

Emergency departments represent less than two percent of the nation's one trillion dollar health care expenditures.

Supporters of national patient protection laws say there's no evidence the number of ER visits increases when patients have guaranteed emergency coverage.

The American Association of Health Plans says the bulk of ER horror stories are old news -- the majority of health plans today follow codes of conduct that ensure emergency care will be covered.

"Our members are working hard to make sure beneficiaries understand their rights, to make sure beneficiaries understand that if they have an emergency, they should go to the emergency room and it will be covered," said Karen Ignagni of AAHP.

Thirty-two states and the District of Columbia have adopted what's called a "prudent layperson" standard. It allows patients with emergency symptoms to seek emergency care without fear that their health insurer will later deny their claim -- something physicians say should be part of a national patient protection law.

"It'll produce a basic minimum standard that all states would have to adhere to," said Rapp.