The September 2016, PACEP (Pennsylvania College of Emergency Physicians) newsletter provides an interesting perspective on balance billing and how this practice negatively impacts emergency service providers and their patients. Under EMTALA emergency care is required to be given but insurance reimbursement is often at the lowest level due to the provider/facility being out of network. The balance is then passed on to the patient, who often has a high deductible plan, leaving them with a hefty financial burden due to an emergency situation.
PACEP is advocating to receive “fair payment” for emergency services. They are looking to mirror legislation passed in Connecticut and Texas which allows for in-network reimbursement rates for emergency services, and also uses the Fair Health database to set fair rates. ACEP is heading this movement and is in litigation with the Federal Government regarding the current balance billing laws, hoping to improve this aspect of physician billing.