ACEP Emergency Care Poll 2012

• Seventy percent of Americans oppose health insurance plans’ efforts to deny payment for emergency visits when they believe they are having medical emergencies — even if they are ultimately diagnosed with non-urgent medical conditions. [ACEP & Harris Poll May 2012]
  • Private plans and state Medicaid offices increasingly want to cut back on payments for emergency care — despite emergency care being only 2 percent of the nation’s health care dollar. (private plan examples include Univera and Blue Cross/Blue Shield in New York that issued reports on the need to cut back on “unnecessary” emergency visits)
  • The state Medicaid office in Washington State was set to implement a zero tolerance policy to deny payment for Medicaid emergency patients. Denials were to be based on a list of 500 final diagnoses that the state deemed to be nonurgent. Fortunately, the Governor suspended the plan, but this issue is ongoing.
  • Under the Washington state plan, if you have chest pain, and it turns out you have a hiatal hernia, which is a nonurgent condition, the health plan won’t pay for it.
  • This violates a federal law known as the prudent layperson standard. People should know that most health plans are required by law to pay for ER visits if it seems like an emergency to you the patient, even if it turns out to be less serious.
  • Health plans are notorious for not paying claims. For YEARS they have tried to cut back on paying for emergency care — usually based on the diagnosis, not the thing that brought somebody to the ER in the first place.
    
• If you agree that your health plan should pay for your emergency care if you think you are having a medical emergency, go to www.OurEmergency.org and sign the petition.
  
• More than three-quarters (76 percent) of Americans say health insurance should pay for every emergency visit.
  • 70 percent of Americans oppose efforts by insurance companies to deny payments for ER visits when patients believe they are having medical emergencies that turn out to be non-urgent medical conditions.
  • More than half (51 percent) said they would be LESS likely to seek emergency care if they were told health insurance plans would not pay (if they did not have a medical emergency).

[NOTE: The survey was conducted online within United States by Harris Interactive, on behalf of ACEP, from April 16 to April 17, 2012 among 1,026 adults age 18 or older. No estimates of theoretical sampling error can be calculated.]

• 85 percent of Americans who have been to emergency departments said they could not have waited to see their regular medical providers.
• The poll results shows that emergency departments are filled with patients who feel they need to be there. People are coming because they need care and if they have a non-urgent condition, such as a bladder infection, it’s because they have no place else to go and the problem feels like an emergency to them.
• Only 8 percent of emergency visits are considered non-urgent, according to the CDC. The CDC also says “non-urgent” does NOT mean unnecessary. Care is still required in 2 to 24 hours, which can be serious.
• Patients should never be forced to self-diagnose their medical conditions out of fear their health insurance won’t pay. Even a skilled physician does not know your diagnosis when you walk in the door. 
  
• Did you know that emergency care is just 2 % of the nation’s health care dollar?
• 90 percent Americans said they were surprised at that statistic (ACEP/Harris 2012). Most thought it was much higher (63 percent say it is between 26 and 75 percent.)
• According to government statistics, emergency care is $47.3 billion (AHRQ 2008) of the total $2 trillion of total health care expenditures (HHS Actuary 2010).