Health Insurance | The End Of Out-of-network Health Insurance Hospital Bills?
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.
If they choose to go outside of the network, policyholders will not receive a discount. From that full price, the person will have to pay most or all of the amount. That is because many health insurers have higher co-insurance percentages or co-payments for out-of-network care.
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.
Related posts:
- Health Insurance | Will Health Insurance Reform Prevent Overuse Of Hospital Emergency Rooms?
- Health Insurance | Using Your Family Health Insurance Georgia Provider Network
- Health Insurance | Avoid Surprise Health Insurance Bills!
- Health Insurance | The Good, The Bad, And The Ugly Of An Hmo Health Insurance Ga Plan
- Health Insurance | Health Insurance Plans
