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" Access to In-Network Emergency Physicians and Emergency Departments Within Federally Qualified Health Plans in 2015 "
Dorner, Stephen C.; Camargo, Jr., Carlos A.; Schuur, Jeremiah D.; Raja, Ali S.
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AL
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| Record Number
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933383
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LA7x22k9hg
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| Language of Document
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English
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| Main Entry
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Dorner, Stephen C.; Camargo, Jr., Carlos A.; Schuur, Jeremiah D.; Raja, Ali S.
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| Title & Author
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Access to In-Network Emergency Physicians and Emergency Departments Within Federally Qualified Health Plans in 2015 [Article]\ Dorner, Stephen C.; Camargo, Jr., Carlos A.; Schuur, Jeremiah D.; Raja, Ali S.
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| Title of Periodical
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Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
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17/1
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2016
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| Abstract
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Introduction: Under regulations established by the Affordable Care Act, insurance plans must meet minimum standards in order to be sold through the federal Marketplace. These standards to become a qualified health plan (QHP) include maintaining a provider network sufficient to assure access to services. However, the complexity of emergency physician (EP) employment practices – in which the EPs frequently serve as independent contractors of emergency departments, independently establish insurance contracts, etc… – and regulations governing insurance repayment may hinder the application of network adequacy standards to emergency medicine. As such, we hypothesized the existence of QHPs without in-network access to EPs. The objective is to identify whether there are QHPs without in-network access to EPs using information available through the federal Marketplace and publicly available provider directories.
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