February 19, 2018
Anthem makes several exceptions to its controversial policy of denying payment for ER visits it deems non-emergency
Responding to complaints from legislators and health-care providers, Anthem Blue Cross Blue Shield has added several exceptions to its recently established policy of not paying for emergency-room visits if it determines there was no emergency.
The policy first took effect in Kentucky, Missouri and Georgia; “Ohio, Indiana and New Hampshire were added to the program in January, after the new exceptions were already in place,” Leslie Small reports for FierceHealthcare.
The exceptions include patients who:
* are sent to the ER by another provider, including an ambulance
* visit an ER between 8 p.m. Saturday and 8 a.m. Monday, or on a major holiday
* are younger than 15
* live more than 15 miles from an urgent care center
* are traveling out of state
* receive any kind of surgery
* get intravenous fluids or IV medications, or an MRI or CT scan
* have an ER visit associated with an outpatient or inpatient admission
“Anthem said the changes went into effect Jan. 1,” Shelby Livingston reports for Modern Healthcare. “It will apply the exceptions to any previously denied claims.”
The company said in a prepared statement, “Anthem stands by our belief that emergency rooms are an expensive place to receive routine care. The costs of treating non-emergency ailments in the ER has an impact on the cost of healthcare for consumers, employers and the health care system as a whole.”
The changes did not satisfy the American College of Emergency Physicians. “This is still a fundamentally flawed policy,” Laura Wooster, the group’s associate executive director of public affairs for the American College of Emergency Physicians, told Small. “Making fixes around the edges doesn’t end this dangerous policy that’s really going to scare patients away from going to the ER or even considering going to the ER.”
Wes Brewer, former president of ACEP’s Kentucky chapter, told Lisa Gillespie of Louisville’s WFPL, “We have hundreds of cases where people with conditions, where I don’t know in what universe you wouldn’t think they’re emergencies, have been denied.”
Small reports, “Anthem’s program was meant to deter members from using the emergency room for illnesses or injuries that aren’t life-threatening. But critics say patients shouldn’t be forced to self-diagnose, warning that the new policies will encourage people to avoid seeking care for serious medical conditions out of fear that their claim will be denied.”
Shannon Muchmore reports for HealthcareDive, “Anthem has said its program denies a small percentage of claims, but the change in policy signals the payer may be worried about the backlash, including from patients who have gone public with denied claims.
Posted by Al Cross at 9:59 AM
Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
