Emergency Medical Services

Hospitals are required to evaluate and provide emergency services to individuals who seek attention for emergency conditions. Most states, and now the federal government, have enacted laws that require insurance companies and other private sources of health coverage to reimburse hospitals for these services. Many states have very provider-friendly laws that prevent payers from denying coverage for emergency services. However, payers persist in denying reimbursement—often based on private contractual language that is vague and not controlling.

TGF identifies applicable laws, interprets private contractual language, and requires payers to cover emergency medical services, thus preventing providers from losing money on care they are required to provide and enforcing rights specifically granted to patients by state and federal governments.

  • Hospitals are required to provide emergency services to individuals who need those services
  • Most states have laws that require insurers to pay for such services
  • Because ER services are often expensive, insurers look for ways to deny payment
  • TGF forces insurers to comply with applicable laws and works on behalf of hospitals to prevent them from losing money on insured patients who need emergency care