Share this article

print logo

Letter: Insurers confuse patients who need emergency care

Insurers confuse patients who need emergency care

I am writing in response to the April 30 Refresh article, “Urgent care sites offer alternatives for ER visits.” The data used by Univera Healthcare in this article is seriously flawed and the American College of Emergency Physicians has taken issue with it. Insurance companies are using misleading data to draw inaccurate conclusions about whether emergency visits are appropriate.

The report – which assesses whether emergency visits for certain conditions could have been avoided, based on the patients’ final diagnoses, not their presenting symptoms – does not take into consideration the national “prudent layperson” standard, which says emergency visits must be covered by insurance companies based on the patients’ symptoms, not their final diagnoses.

People are confused about when to seek emergency care and when to seek urgent care – and insurance companies add to that confusion.

In medical emergencies, it’s critical that people don’t make the wrong choice, because for some medical emergencies, such as a heart attack and stroke, the loss of time can be dangerous. Nearly three-quarters of emergency physicians responding to a poll in 2015 said they treated patients every day who ended up in the ER after first seeking help in an urgent care that was not equipped to care for them. More than half also said that urgent care centers market themselves as alternatives to the emergency department.

A report like this may discourage some people from visiting the emergency department who really should be there. The consequences of that could be (and have been) tragic.

Jay Kaplan, M.D., FACEP

President, American College of Emergency Physicians