Survey: Patients With Skimpy Health Insurance Policies Put Off Care

A poll commissioned by the American College of Emergency Physicians shows many emergency room patients delay care because of high out-of-pocket medical costs.

Dr. Lisa Maurer, an ER doctor at Wheaton Franciscan in Milwaukee said she’s observed it first-hand. Many insured patients don’t understand their policies and get sticker shock when they have up-front costs, Maurer said, which hurts both the patient and the provider.

“When the insurance companies don’t pay emergency room physicians fairly, they have to choose between billing patients for the difference or getting no reimbursement at all for the care they provide,” she said.

According to the survey, 72 percent of doctors saw patients who had co-pays of $200 or more, while 83 percent of doctors said they had patients who had foregone or delayed care because of co-insurance, or high deductibles.

Mauer said high out-of-pocket costs are part of many health policies; not just those sold on federal and state health insurance marketplaces. But since the Affordable Care Act, she said, there are more policies with low premiums and inadequate coverage.

The American College of Emergency Physicians recommends what they call fair and transparent model to pay insurance claims like that of FAIR Health, Inc.

That organization was established in October 2009 as part of the settlement of an investigation by New York state into certain health insurance industry reimbursement practices.

The Wisconsin Association of Health Plans did not respond to an interview request for this story.