In one of our recent blogs, Hospitality Health ER brought light to the Prudent Layperson Standard. This concept is becoming ever so important as more and more patients are selecting standalone ERs for medical care. In short, patients should know that no matter which emergency room you choose —hospital or standalone—your health insurance cannot deny your claim, nor charge you out-of-network rates. Although this piece of legislation has been around since 1997, some insurance companies are still misleading patients with false information to keep them going to certain ER facilities. But under the Prudent Layperson Standard, you have the right to choose.
What is Patient Steering?
Patient steering is when insurance companies provide misleading information to enrollees about which emergency rooms they can or cannot visit. Some insurance companies use scare tactics to prevent enrollees from using certain emergency rooms. They may tell you that you’ll be charged out-of-network rates, which simply isn’t true. What you need to know is that you have the right to select any licensed emergency room you desire, and all ERs should charge at in-network rates.
What Else Should I Know About Patient Steering?
#1. You Can Visit Any Licensed ER Facility. The Prudent Layperson Standard primarily to protect the lives of patients seeking emergency medical care. Because sick or injured patients should be cared for as soon as possible, they should be able to go to any ER facility without hesitation. When insurance companies steer patients away from a qualified emergency room nearby, it can potentially put the patient’s health or life at risk.
#2. All ER Visits are Covered at In-Network Rates. No matter what your insurance plan is, emergency medical care should be covered at in-network rate. If an insurance company informs you that ER services will not be covered at a certain ER facility, this is a violation of the Prudent Layperson Standard. You should report this to your state Department of Insurance.
#3. Contract Commitments. Health insurance policies mandate that insurance companies honor their contract no matter which ER facility you choose. As a patient or employers, you are paying premiums, deductibles, and other costs in exchange for health insurance plans. This includes emergency care, whether hospital emergency room or freestanding emergency center.
Check out our blog to learn more about your rights under the Prudent Layperson Standard. You can also find out more about Hospitality Health ER’s fair and transparent billing process here.