Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

How ER Physicians Really Feel about Insurance Companies

ACEP Infographic

Health insurance companies mislead patients by offering “affordable” premiums but then limiting coverage. That’s the consensus of nine out of 10 emergency physicians in an April poll conducted by Marketing General Incorporated on behalf of the American College of Emergency Physicians (ACEP).

Particularly, 80 percent of emergency physicians polled said that insurance companies have reduced the amount they reimburse for emergency care and nearly two-thirds (61 percent) say most health insurance companies provide less than adequate coverage for emergency care visits to their customers. In fact, 72 percent of physicians reported that they are seeing patients who have had to pay co-pays of $200 or more for emergency care.

“Each day, emergency physicians are seeing patients who have significant co-pays, up to $400 or more, for emergency care,” said Jay Kaplan, MD, FACEP, president of the American College of Emergency Physicians (ACEP). “It might as well be $4,000 for some people. Patients should not be punished financially for having emergencies or discouraged from seeking medical attention when they are sick or injured. No plan is affordable if it abandons you when you need it most.”

Sadly, the increased cost-sharing often leads patients to put off or refuse care. In the poll, 83 percent of physicians have seen patients forgo or delay medical care due to cost prohibitive medical expenses, including co-insurance and high deductibles.

The issue of in-network versus out-of-network care was also top-of-mind for most emergency physicians. Of those polled, 81 percent of respondents feel that states which ban medical providers from balance billing (for out-of-network care) will endanger patients and the medical safety net. However, 60 percent said they had difficulty in the past year finding in-network specialists to care for patients, with a quarter of them saying it happens daily. And 40 percent of member physicians reported health insurance companies have refused to negotiate with their hospital or group for in-network contracting rates.

One thing was very clear, though. Most physicians (91 percent) agree that a new rule from the Centers for Medicare and Medicaid Services, which does not require health insurance companies to use a fair and transparent database to calculate out-of-network payments, will make finding specialists and follow up care for patients more difficult. Incidentally, 79 percent of emergency physicians say the Fair Health database is the best mechanism available to ensure transparency and to make sure insurance companies don’t miscalculate payments.

One other important revelation from the recent survey was physicians’ perceptions of patient knowledge and understanding about health insurance and health benefits. Almost all physicians (96 percent) believe most emergency patients do not understand what their health insurance companies cover for emergency care, and 76 percent do not feel patients generally understand that health insurance policies with “affordable” premiums come with policies that have high out-of-pocket costs.

For more information about the ACEP survey, review the complete results, the fact sheet, or the ACEP press release. ACEP also has released created an “Insist on Fair Coverage” page on their website for physicians wishing to learn more about fair coverage for emergency care.

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com. Infographic provided by the American College of Emergency Physicians Press Kit.


Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

© Copyright 2020