As you know, our patients are experiencing balance billing because more and more insurance companies refuse to fairly reimburse for the care provided in emergency departments nationwide. Emergency care is mandated by federal law, and insurance companies know this. This is why there is no interest by the insurance companies to get emergency physicians “in network.”

An increasing number of patients are seeking emergency care for various reasons, and these patients deserve to be supported by the insurance companies they are paying for coverage. There is a surprise emergency care coverage gap in the patients’ insurance policy, a gap that patients often do not know about due to a lack of transparency by their insurer. An unfair burden is being placed on patients as the insurance companies continue to raise rates and decrease or refuse coverage, all while emergency departments are fighting to keep the doors open and beds staffed.

Here are some other stats that the study failed to include about emergency medicine:

• No-pay (uninsured) patients average 15.4 percent of ED visits (323,400 visits out of 2.1 million). Their payments average $23.35 per visit, with 98.1 percent of the charge written off as bad debt or free care.
• Low-pay (Medicaid and managed Medicaid) patients average 31.4 percent of ED visits (659,400 visits out of 2.1 million). Their payments average $58.71, a fraction of the physician’s hourly compensation cost, including malpractice insurance and billing overhead.
• So a total of 46.8 percent of the patient mix (uninsured and Medicaid) are no- to low-pay but are regularly treated under EMTALA without regard to any ability to pay, de facto free care to almost half of all the emergency department’s patients.

Finally, the article’s authors declared financial conflicts of interest, receiving grant money from the National Institute for Health Care Management, an organization led by the nation’s insurance companies representing $190 million in revenue, within the last three years. This group’s mission is to advance the interests of the for-profit insurance industry. Data are important, but publishing studies from a for-profit industry motivated to deflect blame while boosting profits is unfortunate. Such financial conflicts of interest and intellectual bias cannot be reconciled and most certainly biased the outcome of the study, the manuscript, and the authors’ conclusions.

Emergency physicians deliver high-quality care and take care of all patients 24-7-365. We will continue to spread the true story of emergency physicians and their patients. We will aggressively implore NEJM to fully vet health policy articles and to refrain from publishing erroneous and bias data with inflammatory rhetoric under the guise of high-quality, methodologically sound, peer-reviewed literature published in a reputable journal.