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Emergency Definition Debated

February 13, 1997
By: Elizabeth J. Zack
State Capital Bureau Exactly how does your HMO define an emergency?

The state government may be stepping in to answer that question.

Liz Zack has the story from Jefferson City

Story:
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OutCue: SOC

Citizens and interest groups testified before the house committee on critical issues to suggest changes to a bill that would regulate managed care in the state of Missouri.

The bill addresses several key issues that constituents identified as problems with the managed care system.

Sandra May, an HMO user from St. Charles, brought her son to an emergency room in the state of Texas for treatment of a severe dog bite.

Conflicting administrative reports have left her hassled by the managed care company.

Actuality:
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OutCue: hospital in Texarkana
Contents: She paid the determined $50 copay and is still receiving collection notices

Changing answers about pre-approval was not the only administrative problem addressed by the committee.

Dr. Jerry Kennett of the Missouri Medical Association testified about the amount of labor involved in getting these tentative authorizations.

Actuality:
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OutCue: every day
Contents: One 16 member physician group has 3 people working only on authorizations.

But proponents of the bill were worried about more than hassle.

The managed care reform bill would additionally step in to help regulate the definition of "emergency."

It would also regulate the required procedure to receive treatment for emergency conditions.

Dr. Bob Mecker of the American College of Emergency Physicians stressed the importance of getting treatment fast.

Actuality:
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Mecker also voiced his support of the bill's definition of emergency, which leaves the distinction up to the judgment of a "prudent lay person."

Currently many HMO's do not cover broken limbs as a reason to seek emergency help.

But as the hearing wore on into the night, there were also those who testified in opposition to the bill.

Dan Meehan of the Missouri chamber of Commerce voiced his concern about the cost of the regulation.

Actuality:
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OutCue: make it so
Contents: Asks the committee to keep the costs low and affordable.

Meehan was joined in his opposition to managed care regulation by Chris Long of Associated Industries.Actuality:
RunTime:
OutCue: position on this bill
Contents: Associated Industries is worried about member cost

The committee heard testimony until the early morning.

They will meet again to discuss the bill before they vote.

From the capitol, I'm Liz Zack.