A recent Miami Herald article, as reprinted by InsuranceNewsNet, opened with a starkly written story about a South Florida mother driving nearly an hour to find in-network emergency care for her daughter after visiting an urgent care. The providers at the urgent care had warned her that the child’s appendix could rupture at any time. Unfortunately, the mother had to drive past two existing emergency rooms — both of which were close by — to find an in-network facility.
Members of Florida Blue and its affiliates can still seek emergency care at hospitals run by Broward Health and Memorial. Health insurers are required to cover emergency services at any hospital in the country as if it’s in-network, even if it’s out-of-network. But, “I don’t know what that means in real-life terms,” [the parent] said.
Questions and scenarios swirled in her head that January night: If [the child] was admitted into an out-of-network ER, would she have to fight with every doctor to get insurance coverage? Would she be forced to transfer hospitals? Would just the ER visit be covered — but the rest not?
This situation was used to highlight the choices patients faced in the wake of a provider network contract negotiation that failed — in this case, between Florida Blue and Broward Healthcare. But it’s not the best example, and for the reason that was stated in the article: health insurers are required to cover emergency services at any hospital in the country as if it’s in-network, even if it’s out of network.
That’s true; it’s based on a federal law called the Emergency Medical Treatment and Active Labor Act (EMTALA). Further, based solely on the information in this article, it appears that the mother could probably have gone to Broward Health Medical Center. Let’s take a deeper dive into why that is, and what likely would have happened had she done so.
