POSTED: June 28th, 2018
POSTED IN: Insurance, Legislative Updates,
A coalition of a dozen medical associations and groups sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today responding to a request for information on price transparency that is included in an annual Medicare hospital payment regulation.
“Emergency physicians believe that it is the insurers’ responsibility to provide clear information about medical costs upfront to patients,” said Paul Kivela, MD, FACEP, president of the American College of Emergency Physicians (ACEP). “While providers and hospitals may be able to provide raw prices to patients, without accompanying information from insurers, little can actually be achieved in the form of true transparency for the patients.”
Dr. Kivela adds that emergency physicians never want to put patients in the position where they are forced to make life and death decisions based on the costs of care. Informing patients up-front or in-advance about their potential out-of-pocket costs could be a violation of the Emergency Medical Treatment and Labor Act (EMTALA) and could cause negative consequences for patient care because people delay medical care out of fear of large bills.
“Health insurance companies have a long history of denying coverage for emergency care, said Dr. Kivela. “No insurance policy is affordable if it abandons you in an emergency.”
Patients can’t choose where and when they will need emergency care and they should not be punished financially for having emergencies. We are calling for transparency by insurance companies and the use of open and independent databases, such as FAIRHealth, to make information on usual and customary physician charges available to the public. This data in turn can be used to inform reimbursement.
“The Emergency Department Practice Management Association (EDMPA) has been working with many other specialties to make sure patients can access information on their health care coverage and are not surprised by a gap in their insurance, said Dr. Andrea Brault, Chair of the Board for EDMPA. “We want to ensure that health insurance companies pay the usual, customary, and reasonable rate for out-of-network care before asking patients to cover the rest of the bill.”
The letter was signed by ACEP and EDPMA, along with Physicians for Fair Coverage, American College of Osteopathic Emergency Physicians, American Society of Anesthesiologists, American Academy of Emergency Medicine, Society for Academic Emergency Medicine, Healthcare Business Management Association, Radiology Business Management Association, American College of Radiology, American Psychiatric Association and Medical Group Management Association.
In addition to this joint group letter, ACEP separately sent comments to CMS on both the issue of price transparency and other issues in the regulation that affect emergency physicians and the patients we serve. EDPMA also separately sent comments to CMS addressing out-of-network and other issues.