FROM INDIANA PUBLIC BROADCASTING
Emergency physicians often order tests or lab work to rule out serious concerns when treating patients. Insurance companies sometimes refuse to reimburse for that care based on the final diagnosis. A Senate committee approved legislation to put limits on when and how insurance companies managing Indiana’s Medicaid plans can deny emergency physician service claims.
The bill applies what’s known as the “prudent layperson standard.” That standard requires insurance companies to provide coverage for emergency care based on symptoms, not the final diagnosis. For example, an emergency physician may give a patient with chest pains an X-ray, even if the final diagnosis was something like indigestion.
Doctor Elizabeth Struble is with the Indiana State Medical Association. She says a lot of people don’t realize this is happening because it’s on the back end of the health care industry.
“There’s a lot of things that happen often to rule out something that is really scary and come to find out that you have something that luckily is not that way.” she said.
Indiana Medicaid has a list of services that are on what is referred to as an “autopay list.” Under the bill, insurers would not be able to deny claims solely because they are not on that list.
The bill now heads to the Senate Appropriations Committee for consideration.
