Those facilities tend to be in the public sector and are more heavily unionized than other hospitals. Other facilities may scrimp on charity care. Including safety net hospitals in managed care networks will guarantee that the uninsured can still get care and will help the facilities survive. Most plans limit or deny payment for visits to an emergency room for illness or injury not considered urgent or life-threatening. Plans have developed several ways of handling emergencies.
Some large plans provide emergency services around the clock at their own clinics and hospitals.
Some plans have a telephone call-in service with doctors or nurses who advise patients as to whether their condition is an emergency. Some look at the patient's symptoms, rather than the diagnosis, to determine whether the patient could have perceived the situation to be urgent or life-threatening. The definition of emergency that a plan uses often determines whether care is covered by the plan. The methods used to compensate managed care providers may encourage them to provide less, rather than more, care to plan participants. Public disclosure of financial arrangements with doctors, as well as information on utilization review standards and decisions, grievance or appeals procedures, and limitations of coverage, are extremely important.