Bill addresses prudent layperson’
HR 2045 narrows the prudent layperson standard so patients would be covered only for an initial but undefined "appropriate screening examination."
"For all other services, including potentially life-saving treatments, emergency physicians would have to certify in writing that the patient needed immediate emergency medical care," Yeh says.
Yet the plan would only be required to cover such care if a "prudent emergency medical professional" would agree with the treating physician’s judgment.
Those additional bureaucratic processes have the potential to delay timely emergency care, says Moorhead. "Therefore, this legislation would establish new loopholes for the managed care industry to second-guess patients and ED physicians about the delivery of emergency services. Patient in severe pain who make a reasonable decision to seek emergency care would not be fully protected," he explains.
3. An amendment was added to the Patients’ Bill of Rights Act (S-326) to protect patients in emergency situations by allowing them to go to the nearest ED without incurring additional costs or copayment charges.
"The Hutchinson-Enzi amendment removes a significant barrier to emergency care," Moore explains. "It states that under the prudent layperson standard, a patient will not incur any higher copayment or liability for seeking emergency services outside their network." n