State should enforce law requiring insurers to cover emergency-room care
Two doctors groups recently asked the Washington Supreme Court to require the state insurance commissioner to enforce a 1997 law requiring insurers to cover emergency-room care. Guest columnist Deborah Senn agrees and argues the state has erred in its interpretation of the law.
Special to The Times
NO one wants to take a trip to the emergency room — but it happens — unexpectedly.
I know that firsthand. I have had two unexpected ski mishaps far from home. When this happens you cannot always control where emergency care is provided. If you are in another city, county or state, it is likely that the doctors who are going to treat you are not contracted with your insurance company.
Is this something you should be concerned about? Hopefully, no, because you should have the confidence that the doctors treating you will be paid and that you will not tumble into bankruptcy because you need emergency care.
The question is at the heart of a legal action filed recently with the Washington state Supreme Court.
We know that insurers should and must control their costs. Insurers have done this one way by creating "provider networks." In simple terms, you pay less out-of-pocket if you go to a doctor who is in the network and insurers certainly have the right to encourage their policyholders to use the physicians in the insurance company network.
If you go outside the network to a doctor, you pay more out of pocket. But that's your choice. The exception to this arrangement occurs when a policyholder needs emergency care and can't choose a doctor from his or her insurer's network. In that situation, the insurer must step forward and pay the cost of treatment. To do otherwise is to thwart the bargain made with its policyholder.
This concept is reflected in Washington law. Policyholders (along with their employers) pay a monthly premium for reliability and peace of mind.
The law passed in 1997 is carefully designed to protect policyholders against financial ruin due to a medical emergency. The law provides that if a policyholder goes to an emergency room, then the insurer must cover the care. When signing the bill, then-Gov. Gary Locke noted this about the new law: "In a medical crisis, families should not be forced to worry about whether or not their health insurance plan will pay for the needed services."
Why insurance companies and the current insurance commissioner are choosing not to enforce the current law that protects Washingtonians is troubling. Policyholders should know that if they appropriately visit a hospital emergency department they will be treated and will not face unanticipated out-of-pocket expenses.
Doctors should not be put in the position of thinking about who's going to pay for their services and how much. The only concern in such a situation should be what the needs of the patient are in order to be successfully treated.
When policyholders find themselves in an unfortunate emergency situation, they want to be assured of two things: They get the best quality care to make them whole again and they will not be forced into bankruptcy for receiving such care. The law protects patient access to the nearest emergency-services doctor, regardless of whether that doctor is in or out of the insurer's network.
I hope the Supreme Court will direct the current insurance commissioner to enforce the 1997 emergency-treatment law as it was designed — to protect the public and not insurers.Deborah Senn was Washington state's insurance commissioner from 1993 to 2001.