Medicaid will choose what they want to cover during ER visits - NBC Right Now/KNDO/KNDU Tri-Cities, Yakima, WA |

Medicaid will choose what they want to cover during ER visits

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KENNEWICK, Wash. -- Emergency room doctors say they often see too many repeat clients, who would be better served by a regular physician, and a new rule aimed to fix the problem is a topic of controversy.

Starting April 1st, Medicaid can decide whether your trip to the ER constitutes an emergency and if they decide it wasn't necessary, they will not cover it.

"The kind of non-emergency  treatment we're trying to eliminate is not people having chest pains, it is people coming the emergency room repeatedly in search of treatment that they know is not an emergency," says Jim Stevenson, the Spokesperson for Washington State Health Care Authority.

But what constitutes an emergency is undefined.  That is the worry, the Washington State Medical Association, Washington State Hospital Association and many ER doctors share.

Dr. Larry Jecha, who is on the board of trustees for the Washington State Medical Association and is the retired Health Officer for Benton Franklin Counties says while this is good in theory, it will have  many negative repercussions.

"It may keep some people from going to the emergency that really do have an emergency.  That's one problem.... The other is that they will go.  They have to be seen and there's no source of payment.  So then the payment shifts from the state back to the hospitals and the physicians," says Jecha.

Stevenson says, this will save the state about $21 million dollars per year, but Jecha counters hospitals and the public will end up picking up those costs because federal law (EMTALA) says no one can be turned away from an  ER regardless of payment.  " It will be passed on because if the hospitals absorb it then it will be passed on with higher insurance premiums for the people that use your hospitals."

Stevenson says this is still a work in progress and the Health Care Authority is working with doctors on a list of appropriate emergencies to pay for.  Right now, the list is one
the Washington State Medical Association, Washington State Hospital Association  don't approve of.  "I's going to be partly subjective..It's not going to be a matter of looking down on a chart of codes and finding one that applies," says Stevenson.

Jecha argues patients often don't know what's wrong with them until after a doctor diagnoses them, and by that point it could be too late and they'll end up with a bill they can't afford.

"Many people will say I have chest pain, its not going to be covered, so I'm going to stay home. Well if it turns out to be a heart attack then this is serious,"says Jecha.

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