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.