The End of Out-of-Network Health Insurance Hospital Bills?
Posted: Friday, May 21, 2010
by Yamileth Medina
VitalOne Health
When seeking emergency care, time is of the essence. The earlier you reach a hospital, the more likely you are to survive--and the better outcome you will receive.
Unfortunately for many, this important form of health care often interferes with the details of their health insurance plan. Most insured Americans have coverage that entails a list of provider networks. If they choose to visit doctors, hospitals, or laboratories within that network, their insurer will pay most of a discounted rate.
While this makes sense as a method of saving money, few people have a choice in an emergency situation--especially if they live in or travel to a rural area. In that case, only one hospital may be open within a viable distance.
According to the Obama administration's healthcare reform law, this awkward situation will soon change for the better. It forces every health insurance plan with emergency coverage sold after September 23rd to reimburse out-of-network hospitals for the same amount they would if the hospital was within their network.
Insurers are now to go by the "prudent layperson" rule when considering ER claims. That means that if a normal person would deem a hospital visit necessary based on initial systems, the claim must be paid even if the actual diagnosis turns out to be minor. Experts give the example of chest pain: it could be a heart attack or indigestion, but the patient cannot be financially penalized if an outside person would have reasonable belief that it was the former. As a result, fewer patients will delay treatment to the point where it is far more expensive and less effective.
In addition, health insurance companies will be forbidden from requiring patients to receive prior authorization from a primary care physician before going to the emergency room. Doing so is difficult when time is of the essence.
Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they can find quality health insurance plans right now. Yamileth lives in Miami, FL.
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