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Insurance Industry Drives Patients to Sacrifice Necessary Medical Care

Seven in 10 emergency physicians responding to a new poll are seeing patients with health insurance who have delayed seeking medical care because of high out-of-pocket expenses, high deductibles, or high co-insurance. The poll focuses on how the cost-cutting practices of health insurance companies are affecting emergency patients and medical providers.

In addition, nearly three-quarters (73%) reported seeing increased numbers of Medicaid patients who have delayed medical care, because health plans are failing to provide adequate numbers of primary care physicians ("narrow networks"). The narrow network trend is growing among health plans that want to hold down costs and discourage patients from seeking medical care. About two-thirds (67%) of the doctors reported that primary care physicians are sending patients to emergency departments to receive medical tests or procedures when health insurance companies refuse to cover them in an office setting.

"This is a scary environment for patients," says Jay Kaplan, MD, FACEP, president of the American College of Emergency Physicians (ACEP). "Many patients are motivated by fear of costs and not by the seriousness of their medical conditions. The insurance companies are shifting costs onto patients and medical providers as they attempt to increase their bottom lines, and this threatens the foundation of our nation's medical care system. They call it cost-cutting when in reality it is profit-boosting. In addition, health insurance companies are shrinking the number of doctors available in their networks, making it more likely that patients will be forced into out-of-network situations."

According to the poll of 1,433 emergency physicians, conducted by the ACEP in September 2015:

  • Sixty percent of the doctors reported having difficulty finding specialists for their patients, because of narrow network plans that limit the number of medical providers.
  • More than 80% reported treating patients who said they had difficulty finding specialists to care for them, because health plans have narrow networks.  
  • Sixty-five percent said they are seeing an increased number of patients in the emergency department, in large part because health insurance companies are failing to provide an adequate number of primary care physicians to support the needs of communities.
  • Seventy-three percent reported seeing increased numbers of Medicaid patients because insurance companies were failing to provide adequate numbers of primary care or specialty physicians for their patients.
  • Twenty percent reported considering for themselves or knowing other emergency physicians who were opting out of health insurance networks, with nearly 90% of them saying the reason was because health plans were not willing to negotiate reasonable market rates for services.

"Insurance industry claims about 'surprise bills' are disingenuous since they created the 'heads I win, tails you lose' environment," Kaplan says. "Balance billing would not even exist if health plans paid what is known as 'usual and customary' payment in the insurance industry—what is also known as 'fair payment.' Emergency patients are especially vulnerable because health plans know that emergency departments never turn anyone away. Health insurers have been taking gross advantage of patients and medical providers since the Affordable Care Act (ACA) took effect, arbitrarily slashing reimbursements to physicians by as much as 70%. Patients and physicians should band together to fight these dangerous insurance industry practices." 

Kaplan also questioned why four of the largest insurance companies had the resources to merge, given the ACA requires insurers to spend at least 80% of premium revenue on medical care. 

"Isn't the goal of the 'Affordable Care Act' to make health care more affordable?" Kaplan asks.

Source: American College of Emergency Physicians