Payment Fears Drive Americans to Delay Emergency Care

Approximately one in four Americans reported worsened medical conditions after postponing an emergency department visit due to cost and insurance coverage concerns, according to a recent poll. 

Many participants also indicated they are currently paying more or “much more” for insurance than in the previous year, while twice as many respondents said their health insurance coverage has declined (30%) than those who said it has improved (15%) during the same time period.

“As a physician, it greatly concerns me that people are waiting until their medical conditions deteriorate to seek emergency care, which can have lifelong consequences,” Jay Kaplan, MD, president of the American College of Emergency Physicians (ACEP), said in a press release. Dr Kaplan also noted that patients, as well as physicians, are often unable to accurately identify a medical emergency without proper screening, and that insurance coverage or other factors should not place them in a position to determine whether emergency care is required.

The survey, which was conducted by Morning Consult on behalf of the ACEP, polled 2,016 registered US voters on several topics related to emergency care, medical payments and insurance coverage. 

Among these respondents, 24% said they lost access to doctors previously in their insurance companies’ networks. Within the past year, 30% of participants reported putting off emergency medical care as a result of cost, and 19% said they were immediately redirected from an urgent care center or doctor’s office to an emergency department due to the severity of their condition. Fifty-five percent responded that they are paying more for insurance than in the previous year, while 28% reported that they did not know what portion of an emergency room visit their health insurance company would cover. 

Dr Kaplan said that many insurance providers have a “long history” of denying claims based on a final diagnosis instead of the patients’ symptoms, a practice that complicates the decision to seek emergency care. In addition, they often take advantage of patients’ unawareness when selling coverage policies, leading their customers to take on a larger portion of an emergency bill than expected. 

“Insurance companies are misleading patients by selling so-called ‘affordable’ policies that cover very little until large deductibles are met, and the companies are blaming medical providers for charges,” he said. “Many people don’t realize this until they need medical care, and then they are shocked at how little their insurance pays.” —Dave Muoio