What to do when you need emergency care

What to do when you need emergency care

It has to be said: Patients shouldn’t have to be shrewd when navigating a system that’s supposed to care for them at their most vulnerable, or risk both their life and their finances. And yet, that’s the health care system the US has.

It’s hard for people to tell when a private equity firm has taken over a local emergency room. It’s not like the firm slaps its logo on the side of the building. Patients usually don’t even know until they get a bill that an investment company had a hand in determining who saw them in the emergency room and what kind of workup they ordered, says McNamara.

Given that reality, anyone who may one day visit an emergency room in the middle of a crisis — that is to say, nearly everyone — should know how to protect themselves, says Patricia Kelmar, who directs health care campaigns for the Public Interest Research Group (PIRG). There are things you can do to ensure you don’t end up with an astronomical bill.

Know where to go and who is treating you

Some situations don’t permit much decision-making about which emergency room you’ll go to or how you’ll get there. Still, it’s worth making an advance plan for where you’ll go if you have the option.

Cooper, the health economist, says an emergency room’s ownership isn’t the only thing that matters in deciding whether to go there in an emergency. If a private equity-owned ER sees a higher patient volume than others and is affiliated with an academic institution, it may still be the best option.

Even with the No Surprises Act in place, care from in-network doctors at in-network hospitals is far less likely to result in unpleasant bills. So before you need an emergency room, check with your insurance company to see which ones are in network and nearest to you. Once you’re at an emergency room, Cooper suggests asking to see an in-network physician.

Make a plan for how to get there

Ambulance transport is unlikely to be cost-free for most Americans, so if you need to get to an emergency room and you’re in stable condition, it’s worth trying to get there in other ways.

Air ambulances are covered by the No Surprises Act, but ground ambulances are not, and are unfortunately often out-of-network for many people. The ones owned by private equity are especially likely to be wildly expensive. Nevertheless, many states have laws to protect consumers from outrageous ambulance bills — but only if their plan is state-regulated, which means about 60 percent of insured people are still unprotected. You can figure out if yours is one of them by contacting your state’s insurance department.

You can also work with your insurance company and the ambulance company to negotiate big bills; legal aid organizations can also provide assistance.

Understand what you’re signing

Non-emergency hospital departments (for example, the ones that would take care of you if you had to stay in the hospital for more care after an ER visit) are allowed to ask you to sign away your No Surprises Act protections. The form they use to do this is, totally unironically, called a Surprise Billing Protection Form.

Emergency rooms, however, aren’t allowed to ask you to sign this waiver. If they do, say no and report the violation to the No Surprises Help Desk by calling 1-800-985-3059. Almost every US hospital still has to provide care for you under US law.

If you get a wonky bill, file a complaint

If you do still end up with a nonsensically large bill, you can push back and appeal decisions — again, by reaching out to the No Surprises Help Desk.

Additional guidance on your medical billing rights is available on the PIRG website, and legal and other help may be available from organizations like Dollar For and local legal aid groups.

Demand better from community leaders and elected officials

There are better approaches to solving emergency medicine’s problems than by doing hand-to-hand combat with private equity’s worst practices. Reducing the overall harm requires change on a systemic level.

Zirui Song, a Harvard health economist and internist who studies private equity in health care, says those changes include better enforcement of the laws we have aimed at preventing consolidation, fraud, and abuse; closing tax loopholes and other laws that allow private equity firms to conduct business while taking on minimal financial risk; and requiring transparency around private equity health care acquisitions and health care prices. These are all subjects you can contact your elected officials about.

You can also ask to join the board of your local hospital, says McNamara. At nonprofit health systems in particular, these groups are required to include people from the community. As a member, you could learn more about how private equity works and say, “We don’t want private equity in our community.”