I’ve just sent the following letter, with minor variations, to Sen. Kerry, Rep. Capuano, State Sen. Tolman, State Rep. Honan, and Martha Coakley (who will almost certainly soon be Sen. Coakley). If you’re as fed up as I am with this state of affairs (the incident described below is not the first time we’ve been charged a large ER copayment for something which really, truly, required an ER visit), please contact your elected representatives and ask them to do something about it.
Dear Senator Kerry,
Recently, my wife was woken in the middle of the night by persistent abdominal pain so intense (she described it as much worse than natural childbirth) that it caused her to vomit and prevented her from sitting up. Of course, I drove her straight to the emergency room of our local hospital.
Thirteen hours later, she was diagnosed with a kidney stone and discharged. This diagnosis was confirmed by her primary care physician in a followup visit several days later. Both the ER staff and my wife’s PCP confirmed that going to the ER was both necessary and appropriate.
Several days later, I received a bill from the hospital for the $100 ER copayment required by my insurance company. Herein lies the crux of the issue about which I am writing.
Many insurers waive the ER copayment if the patient is admitted to the hospital for inpatient care. This policy is supposedly to deter inappropriate use of the ER for non-emergency care and for visits which could have been avoided through appropriate preventive care. This is a goal which I support, since inappropriate ER use wastes money and resources and contributes to increased health-care costs for everyone.
However, if this were truly the purpose of the copayments, then they would be waived not only when the patient is admitted, but also when his or her final diagnosis was, in fact, one that required emergency care.
My wife’s PCP told her that although ER copayments were indeed originally intended to deter inappropriate ER use, most PCP’s believe that this purpose has been abandoned. Insurers now consider ER copayments just another source of revenue, one which has become increasingly lucrative as more conditions have become fully treatable in the ER (for example, only a few years ago, my wife would have been admitted to the hospital).
I understand that insurers must charge premiums and copayments sufficient to cover their costs. However, revenue policies which put policyholders at risk should not be permitted. Large ER copayments which are not waived for justified ER visits deter people from going to the ER for real emergencies. This puts people’s health, and even their lives, at risk.
The solution to this is straightforward: insurers should be required to waive the copayment for any necessary ER visit, i.e., any urgent, sudden-onset condition for which no other appropriate treatment options were currently available and for which waiting until such options were available could threaten the patient’s health, regardless of whether hospital admission is required.
I ask you to use your position to work to enact legislation to address this serious issue.