Health reform at 6 months: Protecting your choice of doctor and access to emergency services

National health reform turns six months old on Sept. 23, when a variety of new rules and regulations take effect. In this weeklong series, we highlight how benefits will change for consumers in the near term. You can also find videos, news alerts, RSS feeds and other information at our health reform website.

Much was made during the reform debate about protecting peoples’ rights to choose their own doctor and have access to emergency services without worrying about higher costs if they go to an out-of-network emergency room. Within a part of the legislation, called “The Patient’s Bill of Rights,” there are requirements around these two issues. So what does that mean to you?

Choice of health care professional:

If you are in a health plan that has a network of physicians, you have to choose a primary care provider in that network. That’s something we’re all pretty used to doing. The law now says that parents can elect to have a pediatrician serve as their child’s primary care provider as long as that doctor is in the network.

Sometimes, you can’t see a specialist unless your primary care provider gives the okay. However, the law now says that women must have direct access to a health care provider who is authorized by the State to provide obstetrical or gynecological care without a referral or prior approval as long as that provider is in the network. This is aimed at giving women more flexibility in determining what kind of care is right for them.

People can make these choices without prior authorization from their insurer or a referral from their doctor. For more specifics about these options, see our “Patient’s Bill of Rights” reform alert.

Under Michigan law, Blues members have had flexibility in choosing OB/GYNs or pediatricians as primary care providers for a long time, so they are not really impacted by this regulation.

Coverage of emergency services

If you have the misfortune of getting seriously injured or sick while out of town, the last thing you want to worry about is if you’ll have to pay through the roof for seeking emergency care away from home. The reform legislation aims to alleviate this concern.

Now plans that provide any benefits for emergency services in hospital emergency departments must provide that coverage without prior authorization or higher fees for out-of-network emergency services. 

Since all Michigan hospitals participate with the Blues, our members are always covered. And our connection to the entire Blue Cross Blue Shield system ensures they have access to quality emergency services when they venture out of state. While we have to make some minor administrative tweaks, the Michigan Blues are already mostly compliant with this regulation. For more details, see our “Patient’s Bill of Rights” reform alert.