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CQC: Emergency Care Directive Risks Harm, Increased Costs to Patients

Group calls on insurance commissioners to reject dangerous new policy

WASHINGTON – Consumers for Quality Care (CQC) sent a letter today calling on the insurance commissioners in four states to reject a new directive from Anthem Blue Cross/Blue Shield that would force their policy-holders to pay for emergency department visits that are ultimately not diagnosed as emergencies.

CQC is a new advocacy organization that launched earlier this month to shine a light on the obstacles and barriers that consumers are facing in the health care system.

“In an emergency situation, patients with Anthem Blue Cross/Blue Shield will too often be forced to be their own doctor, evaluating whether their head pain is a simple headache or a stroke, or if the nausea they’re suffering is only gas or if it is a heart attack,” CQC board members wrote. “Making health care decisions in a non-emergency situation can be trying enough. Making them in a split-second is an even greater challenge.”

A 2013 study in JAMA found an 88.7 percent overlap in complaints or symptoms experienced during emergency and non-emergency situations.

“We firmly believe the steps Anthem Blue Cross/Blue Shield is taking will only lead to more costs, greater risks, and less confidence in health care delivery for consumers,” the board continued. “We also recognize that it puts hospitals and providers in an untenable position. When a patient is taken to a hospital covered under their insurance only to receive a bill from that hospital after their claim is subsequently denied, they’ll look to providers, hospitals, and officials like you, with questions and outrage. We are asking that you reject this new policy from going into effect in your state and to do everything in your power to push back against Anthem Blue Cross/Blue Shield.”

According to the Kaiser Family Foundation’s analysis of the National Health Interview Survey, 13 percent of adults reported delaying or going without health care due to costs in 2015. This will likely increase now that patients run the risk of getting a surprise medical bill after an insurance company decides their situation wasn’t truly an emergency.

CQC focuses their effort in support of the following principles:

  • Ensuring that high-quality, comprehensive health care is available and affordable to all Americans;
  • Improving insurance design to better meet the needs of consumers; and
  • Transforming the health care delivery system to put the patient at the center.

It is led by a board of directors that includes the Honorable Donna Christensen, physician and former Member of Congress; Jim Manley, former senior advisor to Senators Harry Reid and Edward Kennedy; and Scott Mulhauser, visiting fellow at The University of Pennsylvania and former senior advisor to the Senate Finance Committee and Vice President Joe Biden.

To learn more about Consumers for Quality Care and the issues consumers are experiencing, visit www.consumers4qualitycare.org.

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Letter text is below: 

June 27, 2017

Superintendent Maria T. Vullo
New York State Department of Financial Services
One State Street
New York, NY 10004-1511

Director Chlora Lindley-Myers
Missouri Department of Insurance
P.O Box 690 Jefferson City, MO 65102-0690

Commissioner Nancy G. Atkins
Kentucky Department of Insurance
P.O Box 517 Frankfort, KY 40602-0517

Commissioner Ralph T. Hudgens
Georgia Office of Insurance and Safety Fire Commissioner
Two Martin Luther King Jr. Dr. West Tower, Suite 704
Atlanta, GA 30334

Dear Superintendent Vullo, Director Lindley-Myers, Commissioner Atkins, and Commissioner Hudgens,

As you are likely aware, Anthem Blue Cross/Blue Shield has started informing members in your state that if they utilize emergency department services for a situation later determined by the insurance company not to be an emergency, the patient will be forced to cover the cost. As an organization representing patients in the health care debate, Consumers for Quality Care (CQC) is working to shine a light on issues impacting patient care.

We are writing you today because we know that you share our desire to protect patients. We believe this not only violates the basic tenants of the insurer/patient agreement but this is yet another example of abusive practices that prevents Americans from accessing quality health care.

Increasingly, consumers face fine print that can deny health care services and bankrupt their families. From surprise insurance gaps to unbearable out-of-pocket costs for care and prescription drugs, to impossibly small coverage networks and formularies, there are significant issues that need to be resolved to truly protect patients. This recent development is only the latest obstacle patients now face, and there are numerous issues with the practice.

In an emergency situation, patients with Anthem Blue Cross/Blue Shield will too often be forced to be their own doctor, evaluating whether their head pain is a simple headache or a stroke, or if the nausea they’re suffering is only gas or if it is a heart attack. Making health care decisions in a non-emergency situation can be trying enough. Making them in a split-second is an even greater challenge.

In fact, a 2013 study in JAMA found an 88.7 percent overlap in complaints or symptoms experienced during emergency and non-emergency situations. Under this new policy, a patient wondering if they’re having a stroke, heart attack or other life-threatening condition could forgo treatment to avoid potentially having to pay for the treatment, despite having health insurance coverage.

According to the Kaiser Family Foundation’s analysis of the National Health Interview Survey, 13 percent of adults reported delaying or going without health care due to costs in 2015. This will likely increase now that patients run the risk of getting a surprise medical bill after an insurance company decides their situation wasn’t truly an emergency.

Like you, our concern is first and foremost for patients, who are too often ignored in the health care debate and, as a result, face increasing barriers to quality care. We firmly believe the steps Anthem Blue Cross/Blue Shield is taking will only lead to more costs, greater risks, and less confidence in the health care delivery system for consumers. We also recognize that it puts hospitals and providers in an untenable position. When a patient is taken to a hospital covered under their insurance only to receive a bill from that hospital after their claim is subsequently denied, they’ll look to providers, hospitals and officials like you  with questions and outrage. We are asking that you reject this new policy from going into effect in your state and to do everything in your power to push back against Anthem Blue Cross/Blue Shield.

If you have any questions about this practice or about how CQC can assist, please don’t hesitate to contact us.
Thank you,
Hon. Donna M. Christensen, CQC Board Member
Jim Manley, CQC Board Member
Scott Mulhauser, CQC Board Member
CC: National Association of Insurance Commissioners


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