In 1986, Congress enacted the Emergency Medical Treatment and Labor Act or EMTALA. In 1994 they revised the Act to include the “prudent layperson” definition as a standard for evaluating whether a patient has an emergency condition. Boiled down, it says if you think it is an emergency, then it is to be classified as an emergency. It goes on to stipulate that payment is to be made for the initial evaluation and examination based upon the nature of the patient’s presenting complaint.
This federal law supersedes state law as it pertains to emergency healthcare and insurance companies. So if you present to an Emergency Room (free standing or connected to a hospital), it doesn’t matter if it is in-network or out-of-network. It is supposed to be paid for by your insurance company as though it were an in-network provider.
In Texas, we passed a law this year, Sponsored by State Representative Dr. Tom Oliverson (R-Cypress), HB 3276, that requires ERs to post notice of what, if any, insurance networks they are in.
Here is my question. If ER visits are supposed to be treated as in-network, regardless of their network status. Then why do we need a law requiring them to post a notice of what, if any, insurance networks they are in?