Patient Rights to Medical Emergency Care in 2019
A new law went into effect earlier this month which requires hospitals to list their standard prices online. At Prestige ER we applaud this measure as it provides patients with valuable information which can help them to make better use of their health insurance.
In the instances that you are choosing a preventive or elective treatment, you’ll have time to schedule an appointment with your insurance agent to find out which provider works best with your policy. However, no one really plans to be in an emergency. It can happen at any time to anyone. If you didn’t take the time to investigate, there will be no time for research.
The Fear Factor Exists
During an emergency it should be logical that the best decision would be to rush to the nearest ER, right? Well, yes but unfortunately many patients worry about having their claims denied or not getting the full benefits of their insurance plan due to a deceptive fear factor campaign driven by the very insurance companies themselves. These large companies wish to continue to line their deep pockets through trying to get away with denying as many ER claims as possible and spreading a message contrary to what a patient is entitled to under Texas law. Fortunately, we at Prestige ER are here to explain why you shouldn’t worry. During an emergency, the law is on your side. Let’s cut through the smoke screen so that you are better equipped to make an informed decision so that you may receive the best medical emergency care when you need it.
How Much Will Your Medical Emergency End Up Costing You?
The subject of how much a medical emergency will cost a patient has recently become the source of intense debate across the country.
The reason for this is the policy put forward by Anthem Blue Cross Blue Shield (BCBS), the largest health insurer in the country of denying emergency room treatments, especially those received at out of network facilities, which could make patients liable for the full amount billed.
At the center of the debate is the legality of this policy, physicians, hospitals and even politicians question the measure, stating that the insurance companies are forcing patients to self-diagnose their symptoms during a medical crisis, violating the prudent layperson standard.
Both Federal and State law (Texas Insurance Code 843.002(7) and 1271.155) use the Prudent Layperson Standard for emergency care coverage by health insurance companies.
What is the Prudent Layperson Standard?
The Prudent Layperson Standard is a generally accepted principle in the health care industry that applies to emergency medical care. This standard was created to protect consumers from high medical costs that arise from emergency situations, allowing them to be charged at in-network rates.
This is how the Prudent Layperson Standard defines an emergency:
“Emergency care means health care services provided in a hospital emergency facility, freestanding emergency medical care facility, or comparable emergency facility to evaluate and stabilize medical conditions of a recent onset and severity, including severe pain, that would lead a prudent layperson possessing an average knowledge of medicine and health to believe that the individual’s condition, sickness, or injury is of such a nature that failure to get immediate medical care could:
(A) Place the individual’s health in serious jeopardy;
(B) Result in serious impairment to bodily functions;
(C) Result in serious dysfunction of a bodily organ or part;
(D) Result in serious disfigurement; or
(E) For a pregnant woman, resulting in serious jeopardy to the health of the fetus.”
What Does This Mean for You as a Consumer?
We can all agree that price transparency in the healthcare system needs to be improved and this new law is a step in the right direction, however, when it comes to emergency situations, no reasonable person will expect a victim or their loved ones to conduct extensive price comparisons, request prior approval from their insurance company, and much less self-diagnose to determine if the symptoms are compatible with a medical emergency.
According to a study by The American College of Emergency Physicians (ACEP), there is nearly a 90-percent overlap in symptoms between emergencies and non-emergencies.
These symptom overlaps make it extremely difficult for anyone who is not a doctor to determine the difference between abdominal pain that is life-threatening and abdominal pain that isn’t.
During a medical emergency, every minute can signify the difference between life and death. As a consumer, the law guarantees that you have the right to receive emergency treatment at Prestige ER which offers the highest standard of care in a convenient location and little to no wait times.
At Prestige ER we support our patient’s right to choose where to receive the best emergency care, and we are committed to helping you receive the full benefits of your health insurance plan. For this reason, our manager Elvis Ononobi is available to provide guidance and help you understand the benefits provided by your health insurance policy, as well as file insurance claims on your behalf. And should your claim be denied, we will be available to file an appeal and help you fight for your rights as a consumer.
Know Where to Go in the Event of an Emergency
Prestige ER is Your #1 Choice During an Emergency.
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Prestige ER is honored to serve the residents and those passing through Plano and surrounding cities like Frisco and Allen.
Part of caring for your health is to know where to go in case of an emergency. Please keep in mind that Prestige ER is Open 24/7 every day of the year, if you need us, we are here for you.
We are available 24/7 because an accident can happen at any time. Do not risk your health! Get help from the ER experts when you need it, visit us immediately on .
#1 Medical Emergency Care in Plano, Near Frisco and Allen
Find the ER Specialists at prestigeer.org, We provide the Best 24 HR. Emergency Medical Services in Plano. Don’t Wait in Line for ER Care! Don’t forget that WE STAY OPEN 24/7.
Get back on track to enjoying life, FAST! Experienced, Effective and Caring Emergency Physicians team up with the best On-Site ER care for everything from Minor to Major Injuries and Conditions.
- CT Scan, Digital X-Ray & Ultrasound
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