Anthem’s ER Policy “Completely Unfair To Patients”

By Consumers for Quality Care, on November 10, 2017

Consumers in a few states are beginning to grapple with Anthem’s new Emergency Room policy to reject claims that are ultimately deemed as non-emergencies. One Kentucky woman suffered severe stomach pain and was stuck with a bill when the insurer decided she hadn’t been in an emergency situation. According to The Associated Press:

Alison Wrenne was making waffles for her two young children one morning when abdominal pain forced her to the floor. A neighbor who is a physician assistant urged her to go to the emergency room.

Wrong decision, according to her health insurer. Wrenne was diagnosed with a ruptured ovarian cyst, but Anthem said that wasn’t an emergency and stuck her with a $4,110 bill.

“How are you supposed to know that?” said the 34-year-old from Lexington, Kentucky. “I’m not a doctor … that’s what the emergency room is for.”

Customers in Kentucky and Indiana are directly affected and letters warning customers about using the ER have been sent in Missouri and Georgia.

The policy could have a chilling effect on people who believe they need to visit an ER but are scared it might be deemed non-emergency and then stuck with a large bill.

But some also worry that Anthem’s clampdown will scare patients away from the ER in an actual emergency, especially in cases where major problems may not seem serious at first.

“I think it’s completely unfair to patients,” said Dr. Jesse Pines, who teaches emergency medicine at George Washington University. “It runs the risk of really hurting some people.”

Hospitals claim Anthem has rejected claims without viewing corresponding medical records.

However, hospital officials in Missouri say many of Anthem’s reviews haven’t been this thorough. The insurer has rejected some claims in only a couple days and hasn’t requested patient records before making a decision, said Daniel Landon, a senior vice president with the Missouri Hospital Association…

Other insurers also review ER use but not as aggressively as Anthem, said Laura Wooster of the emergency doctor group. The group has asked Anthem to stop immediately.