Episode Summary

In this episode of From the Clinic to the Courtroom – Health Law Unpacked, host Kevin Rosenquist is joined by attorney Maria T. Santi, founder and managing partner of the Health and Medicine Law Firm. Together, they discuss the troubling reality of emergency room visit denials by insurance companies and what legal steps patients can take when their emergency care isn’t covered.

Maria explains how federal laws like the Emergency Medical Treatment and Labor Act (EMTALA) and the Affordable Care Act (ACA) are supposed to protect patients but don’t always guarantee insurance coverage. She shares real-life cases where insurers have denied life-saving emergency care, the legal recourse available, and the need for legislative reforms to prevent unfair denials.

Tune in to learn how insurance companies justify denials, what patients can do to fight back, and how the law can be improved to ensure fair treatment.

Timestamps

• 00:00 – Welcome to From the Clinic to the Courtroom – Health Law Unpacked
• 00:06 – Introduction to today’s topic: Insurance denials for emergency room visits
• 00:33 – Why emergency denials happen despite EMTALA protections
• 00:52 – Common reasons insurance companies deny emergency room claims
• 01:52 – Case study: A patient denied emergency care after a medically necessary cosmetic procedure
• 03:51 – How hospitals and insurers negotiate coverage behind the scenes
• 05:14 – The insurance denial process: How decisions are made
• 06:14 – Understanding EMTALA and ACA protections for emergency care
• 07:56 – How often emergency room denials are overturned
• 08:55 – The need for legal reforms to protect patients
• 10:50 – The power of the insurance lobby and its impact on legislative change
• 12:37 – How legal action can push insurance companies to cover claims
• 13:36 – The impact of the No Surprises Act on emergency billing disputes
• 14:07 – How Maria stays focused despite the frustration of dealing with systemic insurance issues
• 15:18 – Closing thoughts and where to connect with Maria T. Santi

About the Show

From the Clinic to the Courtroom – Health Law Unpacked is a podcast dedicated to exploring the legal side of healthcare. Hosted by Kevin Rosenquist and featuring attorney Maria T. Santi, each episode breaks down critical issues affecting patients, doctors, and healthcare institutions. From insurance disputes to regulatory changes, this show helps listeners navigate the complexities of health law with expert insight and real-world cases.