Protect the Prudent Layperson Standard

What good is insurance if you can be denied when you seek emergency care?

When you think you are having a medical emergency, you should never question your instincts. Based on your symptoms, if you, as a prudent layperson, feel it is necessary to visit an emergency room, your care should be covered by your health insurance plan. This concept is known as the Prudent Layperson Standard, and legally, health insurers are obligated to cover your care at any licensed emergency medical facility.

Health insurance companies in Texas have made it a policy to erode this patient protection. They will regularly deny an emergency claim if the final diagnosis, not the presenting symptoms, turns out to be non life-threatening. And now, they are trying to oppose a patient-protection bill solidifying the Prudent Layperson Standard in Texas.

HB 2241 and its companion SB 1037, by Representative Dr. Tom Oliverson (R-Houston), would:

  • Eliminate the use of a final diagnosis to deny an emergency care claim.

HB 2035, by Representative Julie Johnson (D-Dallas), would:

  • Reform insurers’ claims review process so that only other emergency physicians can assess emergency room claims.
  • Ensure that ALL licensed emergency facilities, regardless of network status, are eligible to give care to any patient that believes they are having an emergency.

This would ensure that all licensed emergency facilities are eligible to give care to any patient that believes they are having an emergency. When life and death are on the line, it is an unimaginable burden to worry about when you need to seek out care.

We are all patients, so please take action now to support HB2241 / SB 1037, and HB2035 to protect our rights to make our decisions about when we need emergency care!