Wednesday, October 10, 2012

Health Law Guarantees Protection For Emergency Room Visits

Kaiser Health News published an article on a health law that went into effect on September 23, 2010 (six months after the law was enacted). This health law guarantees protection for ER visits.

According to the article titled: "Health Law Guarantees Protections For Emergency Room Visits"  the following occurs:
  • Insurance companies must extend several new protections to patients who receive emergency care.
  • Patients who need emergency treatment will have their costs covered at the same rate, regardless of whether they are treated at "in-network" or "out-of-network" hospitals. 
  • The law also bars health plans from requiring prior authorization for emergency services. And it mandates that plans follow the "prudent layperson" rule. 
    • For example, if a person goes to the ER with chest pain, but ends up being diagnosed with indigestion, the claim has to be covered because going to the hospital under those circumstances made sense.
  • For years, insurance plans have been denying ER claims for a variety of reasons. 
  • There is little data on the overall scope of the problem, a 2004 RAND Corp. study found that at least one out of every six claims for emergency department care was denied by two large HMOs in California. 
To view the full article, please go to the following link: Health Law Guarantees Protections For Emergency Room Visits

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources

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