EDUCATING POLICYMAKERS AND THE PUBLIC
Understanding Emergency Care
What is EMTALA?
Emergency physicians are prohibited by law from discussing any potential costs of care or insurance details with a patient until they are screened and stabilized. This is an important patient protection enacted under the Emergency Medical Treatment and Labor Act (EMTALA) that ensures care is focused on immediate medical needs. However, it also means that patients often do not fully understand the potential costs that could be involved in their care or the limitations of their insurance coverage until they get the bill.
Costs of Emergency Medicine as the Safety Net of Care
Patients with commercial insurance only make up a third of emergency visits in the U.S., leaving the remaining two-thirds without any coverage, or under-compensated by Medicaid or Medicare. Medicaid patients make up the biggest portion of emergency patients: despite comprising just 4 percent of all US physicians, emergency physicians provide two-thirds of all acute care for the uninsured and half of it for Medicaid patients. Medicare coverage also falls short -- adjusted for inflation in practice costs, physician reimbursement has actually declined 26 percent from 2001 to 2023.
Understanding Insurer Practices
Learn how insurance companies are able to rake in record profits by shifting medical costs to patients, who are surprised to discover the costly insurance premiums they paid each month gave little protection against the cost of care due to high deductibles. Over 40 percent of those with insurance from their employer had deductibles over $2,000 in 2019. At that amount, most will pay entirely out of their own pocket for a trip to the emergency department.
Insurers also employ policies such as downcoding and denials that violate the prudent layperson standard.
Policymaker awareness
