EMERGENCY CARE AND MANAGED CARE - A DANGEROUS COMBINATION

Managed care plan subscribers in need of emergency medical treatment o ften face unduly restrictive plan practices. These practices may resul t in life-threatening injury or significant financial obligations on t he part of plan subscribers. They are the result of a managed health c are system that is inadequately regulated and overly concerned with co st control. Economic incentives lead plans to deny approval for emerge ncy medical treatment or to deny retroactively coverage for such treat ment. Emergency medical providers also are harmed by these practices, often forced to treat patients under federal law but denied payment fo r their services. This Article describes this problem in more detail a nd argues that the existing legal framework for preventing and address ing harms to managed care subscribers due to denial of emergency medic al care or coverage is wholly insufficient. Moreover, the author argue s that current law leads to an unjust apportionment of the cost of eme rgency care among providers, subscribers, and plans and that federal l egislation to address these injustices is necessary. The Article criti cally examines the ability of the proposed Federal Access to Emergency Medical Services. Act to protect consumers from harms due to plan den ial of approval for emergency medical treatment and fairly apportion t he cost of emergency care among the relevant stakeholders without sign ificantly increasing health care costs. It advocates the passage of th e Act with minor revisions.