Wise meets with doctors on ER legislation

April 07, 1999|By BRYN MICKLE

MARTINSBURG, W.Va. - Doctors and administrators at Martinsburg City Hospital met with U.S. Rep. Bob Wise, D-W.Va., on Tuesday to discuss federal legislation intended to allay patients' fears that their insurance won't cover visits to the emergency room.

Wise has co-sponsored legislation that would require insurance carriers to pay for emergency treatment, even if a doctor later determines it wasn't truly an emergency.

Under current laws, carriers can refuse to pay emergency room costs for someone who mistakes a malady such as indigestion for something as life-threatening as a heart attack, said City Hospital emergency room doctor Andy Williams.

"For years and years the Red Cross has been educating people about chest pains. We don't want to see insurance companies undermine that training," Williams said.


Hospitals are required by federal law to evaluate everyone who comes in the emergency room regardless of their insurance status, Williams said.

When insurance companies refuse to pay, however, the hospital sends the bill to the patient.

The result, said Williams, is that Martinsburg City Hospital collects 40 cents on the dollar for the "millions" of dollars billed through the emergency room.

The new legislation would require insurance carriers to pay for emergency room visits that a "prudent layperson" would deem legitimate.

While Medicaid and Medicare already use that standard, many private insurance companies and managed care providers do not, Williams said.

The law would also prohibit insurers from requiring preapproval for emergency treatment and patients could go to the emergency room of their choice, Wise said.

"The emergency room is where the buck stops and the current setup presents problems, but I think Congress should be able to deal with those," Wise said.

Hospital officials Tuesday presented Wise with a plaque and thanked him for his efforts on behalf of the legislation.

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