Can My Insurer Deny Coverage For Care At An Out-Of-Network Hospital?

Can My Insurer Deny Coverage For Care At An Out-Of-Network Hospital?

Michelle Andrews answers a reader question about emergency room and out-of-network hospital cost changes under the health law.

QUESTION: I went to an out-of-network hospital but my insurance case worker told me I would be covered since I was admitted through the ER. Can my insurer now deny coverage? -- Michael

ANDREWS: It's unlikely that your insurer would deny coverage altogether if you were admitted to an out-of-network hospital. But it might refuse to cover your hospital care at in-network rates. Consumers now have better protection for emergency care they receive at out-of-network facilities. Under the health care overhaul, in most instances insurers can't charge higher copayments or coinsurance if people wind up getting emergency care at an out-of-network hospital. However, if you're admitted to the hospital following a visit to an out-of-network ER, you're no longer protected from higher cost-sharing. The insurer can charge you for your hospital care based on your plan's regular out-of-network coverage rules.

May 23, 2013