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Watch Out, Texas—Patient “Steering” is Dangerous and it’s Happening Here

Patient Steering

By Eric McLaughlin, M.D., TAFEC Board Member, and Richard Yount, CEO, Patients Emergency Room

 

Steer (verb): to control the course of, to guide by mechanical means 

We automatically think of “steering” in terms of what we do to control the direction of our cars, boats, bicycles, or more metaphorically, the direction we want to head in our lives. But when it comes to healthcare, steering takes on a sinister meaning. Do you know that health insurance companies are increasingly active in steering patients’ healthcare decisions? The results of this dangerous practice could end up costing patients their health, their financial wellbeing, and possibly even
their lives.

Richard Yount, CEO, Patients Emergency Room describes this potentially dangerous insurance company practice:

“As a patient, you should make your own health care decisions. Do not allow yourself to be “steered” by others that may not have your best interests at heart. Access to reliable ER care can be the difference between life and death. Where you seek ER care is your decision—no one else’s.”

Patient “steering” involves someone else getting involved in directing patients’ decisions regarding: (1) who to see for medical care, (2) where to seek medical care and (3) what kind of medical care you need. This can be a good thing when we trust family or loved ones’ recommendations for healthcare providers, or advice on from which hospital to seek care. We trust our family and friends because we know they genuinely want what’s best for us and are invested in our having a positive healthcare outcome.

More and more often, however, your insurance company is the party getting involved in “steering” your patient care. Your insurer has a financial interest in directing you to the cheapest possible care available (no matter the effect on you).

Your insurer has less of an interest in considering the quality of care or the timeliness of care. When minutes—and even seconds—matter, everyone knows that the emergency room is the place to receive rapid care from expertly trained physicians. This is also a more costly option for care – but it is the best-equipped and only place to receive high quality emergency care. Your health insurer has little to no incentive to recommend higher cost alternatives when you seek medical care.  On the other hand, the burden of delayed or inadequate care is solely your burden to bear – not theirs.

Examples of how we see insurers “steering” patients to lower levels of care include the following:

  1. Insurers “steer” patients to the insurer’s own telephone or
    telemedicine service that provides minimal “advice” when the patient really needs to be seen by at least a nurse practitioner in an office setting. The telephonic provider working for the insurer that patients get to talk to can be in a completely different time zone or in another country, where insurers may benefit from even lower cost specialty labor.
  2. Insurers “steer” patients to be seen in an urgent care facility by a nurse practitioner (urgent cares are seldom staffed by doctors) and not to the specialty physician or emergency room that the patient really needs to be seen by.
  3. Insurers “steer” patients to wait until they can get a scheduled visit
    with their primary care physician, usually at great delay and discomfort to the patient.
  4. Insurers “steer” patients to delay or forego medical testing that could
    speed and improve needed medical care.
  5. Insurers “steer” patients to go to general practitioners rather than
    specialists even if a patient knows they want and need to see a specialist.
  6. Insurers “steer” patients to lower cost suburban hospitals rather than
    specialty centers. Sometimes it is cheaper for the insurer if treatment fails.
  7. Insurers “steer” patients away from emergency rooms. The better the emergency room services available, the more they “steer” patients away.

Sometimes it is cheaper for the insurer to completely deny access to or payment for quality care.

Local Texans — EMS providers, doctors, nurses, and legislators are on your side.

Patients— We are fighting for your rights every single day—even as insurers are spending BIG dollars to control and limit your access to high quality emergency
care.

If you think you have been “steered” in a direction that you do not want to go, please share your story with us on our homepage. You deserve access to the best care available.

Has Your ER Claim Been Denied?

If your visit to the emergency room has been denied by your insurance company, or you feel they didn’t cover enough of the costs, we want to hear your story. 

Additionally, have you called your insurance company when you thought you were having a medical emergency and they told you to go to the urgent care? This is patient steering and we want to hear from you.

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