Survey of health maintenance organization instructions to members concerning emergency department and 911 use.
OBJECTIVE
Anecdotal concerns suggest that health management organization (HMO) membership instructions may deter members from calling 911 or going to an emergency department for a perceived emergency. This study examines such instructions, specifically in regard to their definition of an emergency condition and associated instructions.


METHODS
Member instructions were requested from 28 HMOs in 3 large West Coast cities with HMO penetration exceeding 30%. Fifteen (54%) provided membership materials. Features examined included the definition of an emergency, instructions for calling 911, specific instructions regarding chest pain and stroke, and mention of costs associated with emergency care.


RESULTS
Instructions and definitions varied widely. Six HMOs (40%) included chest pain in their definition of an emergency; 2 (13%) included symptoms of stroke. Ten (67%) made mention of calling 911 or going to the ED somewhere within their instructions; 4 (27%) provided no options for calling 911 or seeking ED care. Three (20%) cited higher costs associated with ED care. Eleven (73%) indicated that claims would be denied for visits determined on retrospective review to be nonemergencies.


CONCLUSIONS
Instructions varied considerably. Most did not include chest pain or symptoms of stroke in their definition of an emergency. Most did include directions to call 911 or go to an ED. Other instructions may lead members to call the HMO first during an emergency.
Neely
K W
KW
Department of Emergency Medicine, Oregon Health Sciences University, Portland, OR, USA. neely@ohsu.edu
Norton
R L
RL
D002140:California; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000628:therapy*; D002637:Chest Pain / Q000175:diagnosis / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007255:Information Services / Q000458:organization & administration*; D007345:Insurance Claim Review; D009922:Oregon; D009935:Organizational Affiliation; D016134:Organizational Policy; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods*; D012495:San Francisco; D013689:Telephone