ER doctors say Iowa Medicaid change hurts patients, hospitals

Published: Oct. 24, 2018 at 12:24 PM CDT
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Emergency room physicians are protesting an Iowa Medicaid billing change that they say will harm low-income patients and hospitals.

Starting Aug. 1, Iowa Medicaid no longer allowed emergency rooms to receive full reimbursement for treating some conditions that turn out to be non-emergent.

For instance, if a patient shows up with a splitting headache, the claim will be covered if it's related to an emergency such as a hemorrhage.

But if the headache is just a migraine, patients will be charged copays of $3 or $8 and hospitals would be reimbursed at lower non-emergency rates.

The American College of Emergency Physicians says the change unfairly puts the burden of self-diagnosis on patients and may discourage them from seeking treatment. The group warns that some may be hit with surprise bills and hospitals won't be reimbursed the full cost of necessary treatment.

The Iowa Department of Human Services says hospitals cannot knowingly bill Medicaid patients for non-covered services. Hospitals may still seek full reimbursement by submitting justification of why the patient believed an emergency existed.

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