One of the most critical issues impacting the healthcare of Texans is timely access to healthcare. In fact, the American College of Emergency Physicians gave Texas an F in access to emergency care in their 2014 Report Card. Unethical business practices and nefarious actions by health insurance companies are keeping Texans from being able to choose expeditious and cost effective emergency services.
Independent Freestanding ERs offer a high quality, fast, and cost-effective alternative for acute, unscheduled care. Yet, there is a coordinated effort by health insurers to keep these facilities out of their contracted health networks. As an owner of both Freestanding ERs and Urgent Care facilities, I am very familiar with in-network negotiations and have successfully secured multiple in-network contracts for my Urgent Care Centers. However, when it comes to Freestanding ERs, insurance companies refuse to act in good faith.
Being an in-network provider helps consumers anticipate expected medical bills, and have confidence in the options available to them in the event of an emergency. Even though independent Freestanding ERs are a growing health care delivery model in Texas, insurance companies have shown a systemic resistance to working with us. This is incomprehensible considering that Freestanding ERs provide cheaper and more efficient emergency care when compared to hospital-based ERs.
My experience attempting to become an in-network provider for my Freestanding ERs was time consuming (lasting two years) and, ultimately, fruitless. Currently, none of my Freestanding ERs are “in-network”, although by law, we must see and treat all comers with an emergency. As a physician and ethical business woman, it was frustrating to be bullied while attempting to negotiate a reasonable payment rate on behalf of our patients.
For the few companies that were willing to communicate with me beyond an initial email, they refused in person meetings and full disclosure of methodologies, and attempted to lock me in at a low rate that would be unsustainable for any viable medical practice. It was clear their final goal was to set a low payment rate, and then drive up deductibles and patient responsibility – essentially turning my facilities into a credit card system for the insurance company.
They would claim to use “fair market data” that did not match real data that is widely available. They also stated in writing that they didn’t “have a methodology for evaluating fair payment of services”. These and many other excuses were deceptions meant to deter me from continuing to seek in-network status.
Unfortunately, most Freestanding ER operators have had a similar experience. A recent poll of freestanding ERs in Texas found that 64 percent had not been contacted by a health plan to contract, despite the operators’ repeated attempts to do so. Forty-five percent said their inability to obtain in-network status was due to unreasonably low offers for contract rates, which were too low to allow them to stay in business. In these instances, the only reasonable option for healthcare providers is to opt out. If we choose to accept the ridiculously low payment rates, we won’t be able to sustain our business. Either way, Texans lose.
As an individual insurance policyholder, I experience the same frustration when I question my medical bills. Insurance companies are attempting to obscure their methods for determining usual and customary rates of coverage for patients. The greed consumed Insurance companies have too much power, and lack oversight and accountability to answer for their unfair practices. These dishonest dealings allow insurance companies to pass through increasing amounts of hidden costs to consumers, and drive healthcare providers out of business, all while pocketing the profits.
In Texas, narrow networks are not due to an insufficient number of healthcare providers. In fact, quite the opposite. Many providers are lined up awaiting a reasonable offer from health insurance companies. If insurers truly cared about their enrollees and want to allow them timely access to care, they would allow freestanding ERs to join their networks and offer reasonable payment. We stand by ready and willing to do the job.
Carrie de Moor, MD, FACEP is the Chairman of The American College of Emergency Physicians Freestanding Emergency Centers Section and a member of the Texas Medical Association Board of Trustees.