Help in the Emergency Room
Laws strengthen health insurance coverage in crisis setting
TUESDAY, April 27, 2004 (HealthDayNews) -- "Prudent-layperson" laws in a number of states have helped ensure that people get insurance coverage for emergency room visits.
That's the assessment of a Wake Forest University Baptist Medical Center study in the May issue of the Annals of Emergency Medicine.
To date, 47 states have passed various versions of these laws.
"Prior to these laws, most managed-care plans would determine the necessity for emergency care based more on ultimate diagnoses than presenting symptoms," study author Mark Hall, a professor of health sciences and law, said in a statement.
That meant, for example, that someone with acute chest pain who went to a hospital emergency department might be denied insurance coverage if it turned out that it was indigestion, not a heart attack, that had caused the chest pain.
"Following these laws, such practices appear to have been vastly reduced or to have virtually disappeared. Prudent-layperson laws have helped to catalyze industry-wide changes in how health insurers review emergency department (ED) claims and how they manage ED costs," Hall said.
The American Academy of Family Physicians has more about health insurance.