Surprise Insurance Coverage Gaps
After receiving emergency care at an “in-network” hospital, patients often discover that they
received care from an “out-of- network” physician and owe a lot of money. This is the “surprise
insurance coverage gap.” The patient pays their monthly premium, yet they receive unexpected
“balance bills” for amounts their insurance company refuses to cover – keeping in mind the
insurers are narrowing their networks to reduce costs and maximize profits by subjecting
physicians to inadequate, take-it- or-leave- it contracts.
Physicians in Georgia believe that it is critical to end the surprise insurance gap in emergency
medicine care settings. Physicians have seen their patients’ financial burden increase in dramatic
ways as health insurance companies have narrowed their networks. Health insurance is so
ambiguous that the most sophisticated patients have trouble understanding the rules.
Many patients try to do the right thing and go to a hospital that is in their insurance network during an
emergency – but they often don’t have any way of knowing when a doctor they need to see is in or
out of their network. The Medical Association Georgia and other physician and patient advocacy organizations are calling for state lawmakers to put an end to balance billing in emergency care settings by passing legislation that will close the surprise coverage gap. MAG is also supporting the ‘End the Surprise Insurance Gap’ campaign.
Dr. Matthew Keadey has been an emergency physician in the Atlanta area for nearly 20 years. He
began his career at Emory Healthcare. He now works in the Emory and Grady Health systems. He
is the president-elect of the Georgia College of Emergency Physicians, and he is a member of the
Medical Association of Georgia. Dr. Keadey is an expert in emergency department billing, coding
and reimbursement.
Dr. Mark Bernardy has been a private practice general/interventional radiologist in Georgia for 30
years. He is a member of the Georgia Radiological Society’s Board of Directors. Dr. Bernardy is
the vice chair of the American College of Radiology’s Economics Commission and a board
member of the Radiology Business Management Association. He is active in Georgia politics,
advocating for radiologists, physicians, and patients. His advocacy efforts started with colon
cancer screening.
Drs. Keadey and Bernardy are leading advocates for ensuring that patients have access to fair
insurance coverage in emergency care settings in Georgia.
