The prudent layperson standard would require health plans to base coverage decisions on a patient's presenting symptoms, not the final diagnosis. I encourage all physicians to support enactment of a national prudent layperson standard. Congress applied the standard to Medicare and Medicaid patients in 1997, and President Bush has applied it to federal workers and indicated the provisions of a patients' bill of rights should be applied to all. Health plans that offer emergency care benefits should not expect patients, especially in emergency situations, to self-diagnose. It also sends a dangerous public health message to tell patients not to seek immediate care when they have symptoms of an emergency, as suggested by some health plans.
Emergency departments are an entry point to the nation's health care system.
They are a vital part of the nation's health care safety net. And right now, that system is in crisis with hospital closures, emergency department overcrowding, cutbacks in reimbursement and funding, and a national nursing shortage. Many insurers have failed to pay for emergency department visits and only recently have begun to make some changes. Decreased reimbursements have contributed to this crisis. Every medical specialty group, including the AMA, and every patient group has endorsed the prudent layperson standard and lobbied Congress on its behalf.