Under the PPACA, individuals may use an out-of-network emergency room provider without penalty.

Under the PPACA, individuals may use an out-of-network emergency room provider without penalty.

• A. Without penalty
• B. With a higher copay
• C. As long as they get a referral
• D. If they were admitted to the hospital

Answer: (A)

The key idea is that emergency care is protected from balance billing. When care is an emergency, patients shouldn’t be charged extra just because the hospital or doctor is out of network. The insurance plan is supposed to cover the emergency service at the in-network cost-sharing level, and the provider cannot bill the patient for the difference beyond that amount. This ensures access to urgent care without financial penalties at the moment of a crisis. Referrals aren’t a factor for emergency visits, and whether the patient is admitted to the hospital doesn’t change the protection for the initial emergency service. In short, you don’t face penalties simply for using an out-of-network emergency department.

The key idea is that emergency care is protected from balance billing. When care is an emergency, patients shouldn’t be charged extra just because the hospital or doctor is out of network. The insurance plan is supposed to cover the emergency service at the in-network cost-sharing level, and the provider cannot bill the patient for the difference beyond that amount. This ensures access to urgent care without financial penalties at the moment of a crisis.

Referrals aren’t a factor for emergency visits, and whether the patient is admitted to the hospital doesn’t change the protection for the initial emergency service. In short, you don’t face penalties simply for using an out-of-network emergency department.