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Sustainable Insurance Profits v. The Prudent Layperson: A Battle That Could Cost Your Life

Eric McLaughlin

Board Member of My Emergency My Choice and Physician Partner and Manager Elite Medical Center

Sustainable Insurance Profits v. The Prudent Layperson: A Battle That Could Cost Your Life

We all want lower healthcare costs, right? So, when United Healthcare recently released a sustainability report addressing the rising costs of Healthcare in America – you might be surprised to find out that the results were met with skepticism. 

According to UHC, the report is dedicated to “reduc[ing] health care costs both at an individual and system level.” On the surface, this headline would suggest that UHC actually cares about healthcare costs. However, digging deeper reveals a disturbing narrative. One that UnitedHealth Group is spreading to justify their ever-increasing premiums.

According to the report, it’s the patient’s fault for higher costs… It states,

Sustainable Insurance Profits

“Two-thirds of visits to the hospital [Emergency Department] by privately insured individuals are avoidable, often involving conditions like bronchitis [or] flu” and “$320 [Billion] could be saved over the next decade by treating common conditions in primary care settings instead of the [Emergency Department].”

The Prudent Layperson Standard Is A Basic Civil Right, On Par With Equal Protection Under The Law.

The Prudent Layperson Standard is a lot like another civil rights standard that we all know and respect – the one upon which our entire criminal justice system is based…The Equal Protection Clause. It says that all people must be treated equally under the law regardless of their prior circumstances and in criminal cases, the equal protection clause manifests as the  “presumption of innocence”.  Without it, our system of due process would fail.  

Similarly, in Emergency Medicine, physicians MUST assume that any patient who enters the ER needs to be addressed as if they are having a potential emergency until diagnosed otherwise. Similarly, patients need to have the right to seek whatever care they deem necessary at the time to ensure their life and health are protected. THAT is why the Prudent Layperson Standard exists. It ensures that patients’ rights are placed higher than profits. It gives patients the freedom of choice to seek the level of care they deem necessary at the time, and physicians are legally bound to stabilize, diagnose and treat patients regardless of their ability to pay.   

Without the Prudent Layperson Standard, our system of protecting patients’ rights to choose the time and place of their emergency healthcare would likewise fail.  Insurance companies obviously don’t like the Prudent layperson Standard.

Insurance Companies Must Stop Patient Blaming and Publicly Minimizing Symptoms That Could Be Signs of an Emergency.

There is a 90 percent overlap in the kinds of symptoms found in patients suffering from emergency and non-emergency conditions. Even emergency room physicians will tell you that without a proper patient work-up, they would not be comfortable judging on symptoms alone whether or not a patient is having a medical emergency. 

That is yet another reason why we must protect the Prudent Layperson Standard, and defend emergency providers’ duty to provide care to anyone that believes they are having a medical emergency.

While there are many reasons this stance from UnitedHealth Group is problematic, let’s look into a few real-world situations that point out this policy’s flaws.

1.

You or your child has a high-grade fever, a severe cough, and the condition is worsening. Discerning between a mild flu and the ever-present and deadly coronavirus (or potentially new disease or variant) is difficult for most people. What do you do? Can you schedule an appointment with your primary care physician? Will they have availability today? If they don’t, do you delay your care, or do you seek care at an emergency facility? 

COVID-19 is a very serious disease that has had real-world consequences for both patients and doctors. You can learn more about these consequences at PandemicDenials.com.

2.

It is the middle of the night or on a weekend and your primary care physician IS NOT OPEN. 24-hour emergency facilities become the only place you can turn to. Do you delay your care and decide to sleep it off? As a patient and friend, Bryan almost learned the hard way, ignoring your symptoms and delaying your care can lead to catastrophic and possibly deadly results.

3.

Severe flus and bronchitis can be life-threatening. Insurers purveying fear and doubt in the mind of policyholders and patients alike, scaring them away when they believe they are having a medical emergency could lead to fatal outcomes.

By minimizing the potential severity of common diseases, insurers like UHC are continuing their campaign to diminish the Prudent Layperson Standard and effectively practice medicine without a license. This is an attack on you, the patient — the only person qualified to assess how YOU feel. And it is an attack on emergency medical providers who are the only ones licensed to practice medicine on patients’ behalf.

This attempt to strip away legal rights of patients is simply designed to pad their profits. My Emergency, My Choice has always put Patients Over Profits and fought for the Prudent Layperson Standard. Please help us fight these dangerous practices and deceiving campaigns from insurance companies by filling out the form on this page. 

Nationwide, patients, doctors, and hospitals alike appreciate your time and support, and I personally urge you to share this blog to help save patients’ rights.

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