Managed care plan subscribers in need of emergency medical treatment often face unduly restrictive plan practices. These practices may result in life-threatening injury or significant financial obligations on the part of plan subscribers. They are the result of a managed health care system that is inadequately regulated and overly concerned with cost control. Economic incentives lead plans to deny approval for emergency medical treatment or to deny retroactively coverage for such treatment. Emergency medical providers also are harmed by these practices, often forced to treat patients under federal law but denied payment for their services. This Article describes this problem in more detail and argues that the existing legal framework for preventing and addressing harms to managed care subscribers due to denial of emergency medical care or coverage is wholly insufficient. Moreover, the author argues that current law leads to an unjust apportionment of the cost of emergency care among providers, subscribers, and plans and that federal legislation to address these injustices is necessary. The Article critically examines the ability of the proposed Federal Access to Emergency Medical Services Act to protect consumers from harms due to plan denial of approval for emergency medical treatment and fairly apportion the cost of emergency care among the relevant stakeholders without significantly increasing health care costs. It advocates the passage of the Act with minor revisions.
Diane E. Hoffman,
Emergency Care and Managed Care—A Dangerous Combination,
72 Wash. L. Rev.
Available at: https://digitalcommons.law.uw.edu/wlr/vol72/iss2/2