Are all hospitals supposed to accept any or all insurance?

The Affordable Care Act includes guidelines about health insurance benefits at hospitals.

In the past, each hospital was able to select which insurance plans it would accept. Each hospital could limit coverage for emergency room visits outside its network of emergency health care providers. This could mean financial hardship if you got sick or injured while you are away from home.

New Affordable Care Act rules state that all private health insurance plans offered in the Marketplace will offer the same set of essential health benefits starting in 2014. Ambulatory patient services, emergency services and hospitalization are included items on this list. Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace, and all Medicaid state plans must cover these services by 2014.

You will also have rights to access emergency room services at any hospital. Insurance plans will not be able to require higher copayments or coinsurance if you get emergency care from an out-of-network hospital. They also cannot require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network. This means that when you are travelling away from your hospital network and need to visit an emergency room, your health insurance plan must provide coverage.

Does this apply to all plans? This depends. These rights do not apply to health plans created or bought before March 23, 2010, which are known as grandfathered plans. Check your plan’s materials or ask your employer or benefits administrator to find out if your health plan is grandfathered. However, you still may be responsible for the difference between the amount paid by your health plan and the amount billed by the provider for out-of-network emergency room services.

In Michigan, the Department of Insurance and Financial Services (DIFS) has information about basic health insurance coverage for consumers, including how various health benefits are delivered through insurance plans. The toll-free hotline at DIFS for individual questions is 877-999-6442.

Michigan State University Extension is involved with a national Extension effort to provide information and education about choosing health insurance. To follow the progress or ask a question, follow

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