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ER doctors, insurance companies disagree on shrinking networks

Photo courtesy of Nathanael T. Miller, US Navy

 

Emergency room physicians and insurance companies are blaming each other for shrinking health coverage networks, a scenario that was evident in a poll released Monday.

The American College of Emergency Physicians polled nearly 2,000 ER doctors, many of whom said insurance networks are shrinking, which is decreasing consumers’ choice of specialists and increasing the likelihood a patient will pay out-of-network costs.

 

America’s Health Insurance Plans (AHIP) responded to the poll with a statement saying patients are paying out-of-network costs for specialists because doctors are refusing to participate in networks.

 

Dr. John Powell, medical director at the Christiana Emergency Department, disagrees with AHIP.

 

“If you come to my bedside and you’re having a heart attack. I’m not asking if you’re in-network or out of network,” he said. "ER doctors are federally required to treat everyone regardless of insurance coverage."

 

He argues that insurance companies reimburse ER doctors at lower rates because they can't turn people away, and that’s what’s driving doctors out of networks.

 

Both sides agree however, it’s best to know what your insurance covers before you have an emergency. Statistically, one out of five Americans will visit an emergency department for some sort of condition this year.

 

 

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